Medicare Multiple Procedure Payment Reductions (MPPR) Scenarios for Speech-Language Pathology Services

The following three MPPR scenarios illustrate full payment being made for the therapy procedure with the higher practice expense. These scenarios do not use current fee schedule rates. If there is a single speech-language pathology service daily it will usually be paid without a reduction because of consistently low physical therapy and occupational therapy procedure practice expense values.

Scenario 1

A patient is seen on the same day for a speech-language evaluation (92523) and a physical therapy evaluation (97001).

	92523	97001	Total Payment w/o MPPR	Total Payment w/MPPR
Work	$107.47	$42.99	$150.46	No Reduction = $150.46
Practice Expense	$82.75	$31.17	$113.92	$82.75 + (50% x $31.17) = $98.31
Malpractice	$2.51	$1.79	$4.30	No Reduction = $4.30
Total	$192.73	$75.95	$268.68	$150.46 + $98.31 + $4.30 = $253.07

Scenario 2

A patient is seen on the same day for speech-language treatment (92507) with a speech-language pathologist and 30 minutes of therapeutic exercises with a physical therapist (97110, each 15 minutes).

	92507	97110 Unit 1	97110 Unit 2	Total Payment w/o MPPR	2012 Total Payment w/MPPR
Work	$32.07	$11.10	$11.10	$54.27	No Reduction = $54.27
Practice Expense	$20.48	$10.86	$10.86	$42.20	$20.48 + (50% x $10.86) + (50% x $10.86) = $31.34
Malpractice	$1.73	$0.25	$0.25	$2.23	No Reduction = $2.23
Total	$54.28	$22.21	$22.21	$98.70	$54.27 + $31.34 + $2.23 = $87.84

Scenario 3

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

	92526	92507	Total Payment w/o MPPR	2012 Total Payment w/MPPR
Work	$33.06	$32.07	$65.13	No Reduction = $65.13
Practice Expense	$25.41	$20.48	$45.89	$25.41 + (50% x $20.48) = $35.65
Malpractice	$1.73	$1.73	$3.46	No Reduction = $3.46
Total	$60.20	$54.28	$114.48	$65.13 + $35.65 + $3.46 = $104.24