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CMS will make full payment for the therapy service or unit with the highest practice expense value and reduce payment of the practice expense component by 20% in the office setting and 25% in institutional settings for the second and subsequent procedures or units of service furnished during the same day for the same patient.

Based on policy changes required by the Physician Payment and Therapy Relief Act of 2010, the Centers for Medicare and Medicaid Services (CMS) recently issued a Change Request (7050) and MLN Matters article clarifying that the multiple procedure payment reduction (MPPR) for therapy services in the therapy office setting (eg, private practice therapist offices, physician offices) will be 20% instead of 25%. For all other settings (eg, skilled nursing facilities (Part B), outpatient hospitals, etc) the MPPR amount will be 25%. The MPPR policy, which is effective January 1, 2011, will apply to outpatient physical, occupational, and speech language pathology services that are paid under the Medicare fee schedule. Specifically, CMS will make full payment for the therapy service or unit with the highest practice expense value and reduce payment of the practice expense component by 20% in the office setting and 25% in institutional settings for the second and subsequent procedures or units of service furnished during the same day for the same patient. The MPPR would apply to therapy services when multiple therapy services are billed on the same date of service for the same patient by the same practitioner or facility under the same National Provider Identifier, regardless of whether those therapy services are furnished in separate sessions. The reduction applies across disciplines. The work and malpractice components of the therapy service payment will not be reduced. In addition to the MPPR, other refinements to the fee schedule relative value units will affect payment for 2011. The negative impact of the MPPR will be adjusted by the use of the physician practice information survey data and the Medicare Economic Index rebasing. The net impact of these changes combined in 2011 will be -5%.

Source: PT IN MOTION

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