MPPR Therapy Reduction

Abstract: MPPR reduction to increase to 50 percent effective April 1, 2013.

Introduction
The American Taxpayer Relief Act of 2012 revises the Multiple Procedure Payment Reduction
(MPPR) reduction to 50 percent for all settings, effective April 1, 2013.

Effective January 1, 2011, Medicare applied an MPPR to the practice expense (PE) payment of
select therapy services paid under the Medicare Physician Fee Schedule. Currently, the
reduction is 20 percent for therapy services furnished in office and other non-institutional
settings, and 25 percent for therapy services furnished in institutional settings.

Application
Many therapy services are time-based codes, i.e., multiple units may be billed for a single
procedure. The MPPR applies to the PE payment when more than one unit or procedure is
provided to the same patient on the same day, i.e., the MPPR applies to multiple units as well as
multiple procedures. Full payment is made for the unit or procedure with the highest PE
payment. Effective for claims with dates of service April 1, 2013 and after, full payment is made
for the work and malpractice components and 50 percent payment is made for the PE for
subsequent units and procedures, furnished to the same patient on the same day.2
For therapy services furnished by a group practice or “incident to” a physician's service, the
MPPR applies to all 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.

The reduction applies to the HCPCS codes contained on the list of “always therapy” services that
are paid under the MPFS, regardless of the type of provider or supplier that furnishes the services
(e.g. hospitals, home health agencies, and comprehensive outpatient rehabilitation facilities
(CORFs)). For professional claims, the MPPR applies to the procedures with a Multiple
Procedure (Field 21) value of “5” on the Medicare Fee Schedule Database (MFSDB). For
institutional claims, the MPPR apples to procedures with a Multiple Services Indicator (field
labeled MULTSURG) value of “5” on the therapy abstract file.

For more details please refer to MLN Matters article #MM8206.

Please contact me with any questions at pcucinelli@leadingageny.org or call 518-867-8827