CMS Clarifies Therapy Multiple Procedure Payment Reduction (MPPR) - (Effective January 1, 2011)
The following clarifications have been posted to the CMS website regarding the implementation of the therapy MPPR that will be applied to payment for all therapy services provided on or after January 1, 2011. AOTA has posted related information about the CY 2011 Medicare Physician Fee Schedule (MPFS) final rule and this change resulting from section 3134 of The Affordable Care Act (§1848(c)(2)(K) of The Social Security Act) at AOTA Analysis: Final 2011 Medicare Physician Fee Schedule Rule (Members-only).
The links below to the Medicare Learning Network (MLN) Matters article and Transmittal 7050 clarify that the multiple payment procedure reduction (MPPR) for therapy services in the office setting or a non-institutional setting will be 20 percent; however, the MPPR for therapy services supplied in an “institutional” setting (e.g., SNF, hospital outpatient departments, CORFs) will remain at 25 percent, as originally established by the final 2011 MPFS.
Application of the MPPR to Therapy Services per Patient per Day
The reduction applies solely to the practice expense (PE) portion of the fee schedule payment for “Always Therapy Services” (see AOTA Analysis: Final 2011 Medicare Physician Fee Schedule Rule (Members-only) for list. Full payment is made for the first unit or procedure with the highest PE payment. For subsequent units and procedures, furnished to the same patient on the same day, the PE will be reduced by 20% for services furnished in office settings 25% percent for the PE services furnished in institutional settings.
This reduction 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 (i.e. occupational therapy, physical therapy, or speech-language pathology, in any combination). Please refer to the links below for additional information.
CMS has not yet published the revised MPFS notice, which will provide the updated conversion factor, geographic indices, and other factors that are needed to calculate the actual fee schedule rates. AOTA will post additional information, as received.
CMS Resources
MLM Matters: http://www.cms.gov/MLNMattersArticles/downloads/MM7050.pdf
CMS Transmittal 7050: http://www.cms.gov/transmittals/downloads/R826OTN.pdf
