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

Sample PE RVU Numbers

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

Reference

Medicare Claims Processing Manual

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