American Speech-Language-Hearing Association
December 28, 2010

Medicare Finalizes Multiple Procedure Payment Policy for 2011

The Centers for Medicare & Medicaid Services (CMS) announced December 21, 2010 that therapy services would be subjected to two different Multiple Procedure Payment Reduction (MPPR) rates based on the provider setting. Initially, the final 2011 Medicare Physician Fee Schedule (MPFS), released November 2, 2010, announced that a 25% reduction of the practice expense (PE) would occur for each CPT therapy procedure rendered to the same patient on the same day except for the procedure with the highest practice expense. CMS Transmittal 800 (November 3, 2010) is replaced by Transmittal 826 [PDF] (December 21, 2010), due to changes made by the Physician Payment and Therapy Relief Act of 2010.The policy revision is as follows:

  • Services in office and other non-institutional settings: 20% PE MPPR reduction;
  • Part B services in institutional settings: 25% PE MPPR reduction

CMS has not yet addressed two related problems: how beneficiary co-pay issues will be handled, and what procedure will have no reduction when different therapy disciplines render the same procedure. 

The conversion factor for the 2011 fee schedule has not yet been issued. However, for purposes of illustration only, the following single and multi-discipline MPPR scenarios are provided for non-institutional settings:

A patient is seen on the same day for speech-language treatment (92507) and swallowing treatment (92526).

  92526 92507 Total Payment w/o MPPR 2011 Total Payment w/MPPR
Work
$34.20
$33.18
$67.38
No Reduction = $67.38
Practice Expense
$34.71
$26.80
$61.51
$34.71 + (80% x $26.80) = $56.15
Malpractice
$1.79
$1.79
$3.58
No Reduction = $3.58
Total
$70.70
$61.77
$132.47
$67.38 + $54.81 + $3.58 = $127.11

A patient is seen on the same day for a speech-language evaluation (92506) and a physical therapy evaluation (97001).

  92506 97001 Total Payment w/o MPPR 2011 Total Payment w/MPPR
Work
$21.95
$30.63
$52.58
No Reduction = $52.58
Practice Expense
$57.68
$22.71
$80.39
$57.68 + (80% x $22.71) = $75.85
Malpractice
$1.28
$1.28
$2.56
No Reduction = $2.56
Total
$80.91
$54.62
$135.53
$52.58 + $75.85 + $2.56 = $130.99

Please contact reimbursement@asha.org for further information.


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