Multiple Procedures Payment Reduction [MPPR]:   What You Need to Know

Medicare Change Alert

What is the MPPR? It is a system whereby the CMS will reduce payments to the always therapy codes; the codes OT, PT and ST regularly use to bill Medicare. (See most of these codes listed below).

How does the MPPR work? You will bill just as you always have. CMS will pay the full physician fee schedule amount for one code each day and the rest of the codes will pay at a reduced amount based on a specific formula Medicare has developed.

How does the formula work? Each CPT code, i.e. 97112, is calculated based on three factors:

(1)    Practice Expense (PE); (2) malpractice; (3) work component.

Each component is calculated based on a geographic index measurement and then the total is multiplied by the conversion factor. The portion of the formula being reduced is the practice expense, which will be cut by 25%. This will impact reimbursement for therapy services.  For all but one CPT code billed in a day the practice expense will be reduced by 25%. This cut is across disciplines; the code with the highest PE will be paid in full and then all other codes will be paid at the reduced rate no matter how many disciplines treated the patient that day.

What settings does this apply to? The MPPR applies to all institutional and outpatient settings including SNFs, Hospitals, and outpatient clinics. Private Practitioners and Physician offices receive a 20% reduction to the PE vs. a 25% reduction.

When is this effective? The original 25% MPPR was effective January 1, 2011. The American Taxpayer Relief Act of 2012 legislated that services provided on or after July 1, 2013 will have a 50% MPPR. This would work the same way as the 25% MPPR except the PE RVU will be reduced by 50% versus 25%.

 

CPT/HCPCS Code:  Short Descriptor

92506 Speech/hearing evaluation

92507 Speech/hearing therapy

92508 Speech/hearing therapy

92526 Oral function therapy

92597 Oral speech device eval

92607 Ex for speech device rx, 1hr

92608 Ex for speech device rx addl

92609 Use of speech device service

96125 Cognitive test by hc pro

97001 Pt evaluation

97002 Pt re-evaluation

97003 Ot evaluation

97004 Ot re-evaluation

97010 Hot or cold packs therapy

97012 Mechanical traction therapy

97016 Vasopneumatic device therapy

97018 Paraffin bath therapy

97022 Whirlpool therapy

97024 Diathermy eg, microwave

97026 Infrared therapy

97028 Ultraviolet therapy

97032 Electrical stimulation

97033 Electric current therapy

97034 Contrast bath therapy

97035 Ultrasound therapy

97036 Hydrotherapy

97110 Therapeutic exercises

97112 Neuromuscular reeducation

97113 Aquatic therapy/exercises

97116 Gait training therapy

97124 Massage therapy

97140 Manual therapy

97150 Group therapeutic procedures

97530 Therapeutic activities

97533 Sensory integration

97535 Self care mngment training

97537 Community/work reintegration

97542 Wheelchair mngment training

97750 Physical performance test

97755 Assistive technology assess

97760 Orthotic mgmt and training

97761 Prosthetic training

97762 C/o for orthotic/prosth use

G0281 Elec stim unattend for press

G0283 Elec stim other than wound

G0329 Electromagntic tx for ulcers