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Payments for Medicare Part- B Therapy Have Been Reduced

Learn what is being adjusted, what you can do, and the codes impacted by the MPPR.

Reductions to Medicare Part B Physician Fee Screen - Multiple Procedure Payment Reduction (MPPR)

As part of ongoing efforts to control costs, CMS has implemented a Multiple Procedure Payment Reduction (MPPR) for certain procedure codes related to therapy. You may have heard about a 25% reduction to Medicare Part B for therapy. This is partially true. The reduction or MPPR is not a reduction to the entire amount of the fee schedule or an across the board reduction to all CPT/HCPC codes billed for therapy. Rather, it is a reduction to one component of the fee schedule amount.

Based on information we are receiving, it appears that this MPPR adjustment will reduce most Skilled Nursing Facility's Medicare Part-B payments for Therapy by about 5%.

What Exactly is Being Adjusted?

The Fee Schedule amounts are arrived at using different factors (the rate you see is made up of different pieces) including: 

  • Work Component
  • Practice Experience Component
  • Malpractice Component

We mention this because only one of these factors is being adjusted, the Practice Experience (PE) component. This Practice Experience or "PE" component is being reduced by 25% for each unit performed after the first unit on a particular day.

Not all therapy codes are reduced. Only 46 of the over 100 codes are on the list for the MPPR. Unfortunately these 46 make up about 90% of what SNF therapists typically bill for. There is a list of affected codes at the end of this article.

All in all, the reduction to the SNF's Medicare Part-B revenue is expected to be about 5%.

You Need To Take It Unit By Unit

You will get paid full price for the first unit of therapy performed on any given day, BUT, all additional units of therapy (even if the next unit is an additional unit of the same CPT/HCPCS code) performed that day will be reduced under the MPPR. The following is an excerpt from the Medline Matters article published by CMS:

"Many therapy services are time-based codes, i.e., multiple units may be billed for a single procedure. The Centers for Medicare & Medicaid Services (CMS) is applying a MPPR to the practice expense 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. For subsequent units and procedures, furnished to the same patient on the same day, full payment is made for work and malpractice and 80 percent payment for the PE for services furnished in office settings and other non-institutional settings and at 75 percent payment for the PE services furnished in institutional settings."

You Need To Take It Day by Day

The MPPR reduction calls for a reduction in the PE component when more than one unit of service is billed in a day, whether that is two units of the same service, multiple services by the same discipline or services of multiple disciplines (PT, OT, SLP) in the same day. 100% of the PE is paid for the first unit (the unit with the highest PE). The PE components for all other units billed that day are reduced by 25%.

Something To Consider - If it is possible to avoid multiple units / disciplines on the same day the number of units being reduced will be lower.

You Need Talk With Your Rehab Team

The MPPR may not be the most significant issue you have to deal with, but it is a reduction to your revenue none the less. We advise that you talk with your rehab team about the following:

Strategies to avoid reductions - As discussed above if you can avoid multiple units on the same day you can lower the overall reduction.

The amount you are paying for Part-B services - If you are paying a rehab provider based on a percentage of the Medicare Part-B "Fee Schedule" amount, you need to understand you will receive less than the publishedfee schedule amount for reduced units. Please review the contract and make the appropriate changes to ensure you are paying the correct amounts for Part-B services.

Resources & References - The CMS rule on this was published in the Federal Register on July 13, 2010. A period of comments followed with updates in the November 29, 2010 Federal Register (Vol. 75, No. 228). The final rule was published December 21, 2010 both as Transmittal 826 and MedLearn article MM5070.

Should you have any questions or need further clarification please contact us at Axiom Healthcare Group

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Codes Impacted By The MPPR

"Always Therapy" Services Proposed as Subject to the CY 2011 MPPR Policy

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