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