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Multiple Procedure Payment Reduction 

Posted December 21, 2022

2023 MPPR Rate File

How does the Multiple Procedure Payment Reduction (MPPR) work?

Medicare applies a multiple procedure payment reduction (MPPR) to the practice expense (PE) payment of select therapy services.

This means that full payment is made for the unit or procedure with the highest PE RVU payment.

For subsequent units and procedures furnished to the same patient on the same day, full payment is made for work and malpractice and 50% percent payment cut is made for the PE for services submitted on either professional or institutional claims.

Which codes/services does the MPPR apply to?

The reduction applies to the HCPCS codes contained on the list of “always therapy” services regardless of the type of provider or supplier that furnishes the services.

The MPPR applies to all therapy services furnished to a patient on the same day, regardless of whether the services are provided in one therapy discipline or multiple disciplines, for example, physical therapy, occupational therapy, or speech-language pathology.

2023 Therapy Code List and Dispositions

Does the payment reduction apply to different services or to units of the same service as well?

The reduction applies to both procedures and units.  If the services with the highest PE RVU is a timed code, the first unit will receive full payment and subsequent units will receive the reduced payment. 

Example

Code

Rate

PE RVU

Ranking

Final Allowable Amount

Code A

$96.80

1.05

1

$96.80

Code B

$40.40

.36

2

PE value = 35% x $40.40 = $14.14 x 50% or $7.07.

Allowable Amount = $40.40 - $7.07 or $33.33

Total

$137.20

$96.80 + $33.33 = $130.13

Sample PE RVU Numbers

The code with the highest PE RVU # will be paid in full, subsequent procedures or units will be reduced.

Code

Description

PE RVU

97610

Low frequency non-thermal us

11.52

97597

Rmvl devital tis 20 cm/<

2.12

97161

PT evaluation

1.33

97165

OT evaluation

1.24

97530

Therapeutic activities

0.67

97112

Neuromuscular reeducation

0.49

97110

Therapeutic exercise

0.40

97108

Paraffin bath

0.16

Reference

Medicare Claims Processing Manual

Chapter 5 - Part B Outpatient Rehabilitation and CORF/OPT Services §10.7

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