Multiple Procedure Payment Reduction (MPPR) for Selected Therapy Services

Effective January 1, 2011, Medicare applied an MPPR to the practice expense (PE) payment of selected therapy services paid under the Medicare physician fee schedule or paid at the physician fee schedule rate.1

Previous reductions were 20% for therapy services furnished in office and in other noninstitutional settings and 25% for therapy services furnished in institutional settings. Section 633 of the American Taxpayer Relief Act of 2012 revised reductions to 50% in all settings.1 This revision is effective for claims with a service date of April 1, 2013 or after.1

The MPPR applies to the PE payment when more than one unit or procedure is provided to the same patient on the same day (i.e., the MPPR applies to multiple units as well as multiple procedures).1 Full payment is made for the unit or procedure with the highest PE payment.1 For claims with a service date of April 1, 2013 or after, full payment is made for work and malpractice, and 50% payment is made for the PE for subsequent units and procedures furnished to the same patient on the same day.1

For therapy services furnished by a group practice or incident to a physician’s service, the MPPR applies to all services furnished to a patient on the same day, regardless of whether the services are provided in one therapy discipline or multiple disciplines (e.g., physician therapy, occupational therapy, speech-language pathology).1 This reduction applies to the Healthcare Common Procedure Coding System (HCPCS) codes included in the list of “always therapy” services paid under the physician fee schedule, regardless of the type of provider or supplier that furnished the services.1

For professional claims, the MPPR applies to procedures with a Multiple Procedure (Field 21) value of 5 in the Medicare Fee Schedule Database.1 For institutional claims, the MPPR applies to procedures with a Multiple Services Indicator (field labeled MULTSURG) value of 5 in the therapy abstract file.1 Please visit http://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmattersarticles/downloads/MM8206.pdf to view the CMS MLN Matters® article for additional information regarding this adjustment.

Reference

1. MLN Matters. Multiple procedure payment reduction (MPPR) for selected therapy services. Centers for Medicare and Medicaid Services. Published February 22, 2013. http://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmattersarticles/downloads/MM8206.pdf. Accessed May 30, 2013.