For Medicare Part B therapy
services provided on or after April 1, 2013, the multiple procedure payment
reduction (MPPR) increases from a 25% to 50% deduction in practice expense,
resulting in an approximate 7%–12% cut in total payment for multiple therapy
services provided to a single patient on a single day in a single facility
depending on the code and service details.
The implementation of MPPR
- facilities that provide Medicare Part B speech-language
pathology, occupational therapy, and physical therapy services and bill under
the same provider number and
- providers in private practice, including
speech-language pathologists, who perform and bill for multiple services in a
Calculation of the 50% reduction to practice expense
occurs during claims processing. The beneficiary co-payment should be collected
based on the Medicare fee schedule rate in your area.
Congress included a 50% multiple procedure payment reduction (MPPR) on
outpatient therapy services effective April 1, 2013, in the American Taxpayer Relief Act. Under MPPR, Medicare reduces payment for the second and
subsequent therapy procedures furnished to the same patient on the same day.
Full payment is made for the therapy service or unit with the highest practice
expense value of the code (i.e., support personnel time, supplies, equipment,
and indirect costs) and payment reductions in the practice expense of each
subsequent procedure billed that day will be reduced by 50%, resulting in an
approximate 7%–12% cut in the overall reimbursement of the procedure. It is
estimated that the MPPR on therapy services will result in a $1.8 billion
savings for the Medicare program.
Medicare Fee Schedule Rates: MPPR
For more information regarding
MPPR, please contact the health care economics and advocacy team at [email protected].