(a)(1) The Medicare Multiple Procedure Payment Reduction (“MPPR”) for “Always Therapy” Codes shall be applied when more than one of the following codes is billed on the same day: codes on the Medicare “Always Therapy” list, acupuncture codes, chiropractic manipulation codes.
(2) Many therapy services are time-based codes, i.e., multiple units may be billed for a single procedure. The MPPR applies to the Practice Expense (“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. 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.
(3) 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.
(4) The MPPR applies to acupuncture codes and chiropractic manipulation codes and to the procedures listed in the “Separately Payable Always Therapy Services Subject to the Multiple Procedure Payment Reduction (MPPR)” file of the Medicare Physician Fee Schedule Final Rule. The listed procedures will also have a Multiple Procedure value of “5” on the National Physician Fee Schedule Relative Value File.
(5) See section 9789.19 for the location of the list of codes on the Medicare “Always Therapy” code list, by date of service.