Updated Fee Schedule and MPPR Calculators Now Available APTA has updated its Medicare fee schedule calculator to reflect the $33.9764 conversion factor that will be used in 2011. The fee schedule calculator provides the payment amount for each CPT code based on geographic location. It does not guarantee that a local contractor will pay for the service(s) that is furnished.
In addition, APTA has posted a multiple procedure payment reduction (MPPR) calculator. The MPPR implements a 20% or 25% payment reduction to the practice expense value of approximately 44 CPT codes deemed "always therapy services." The 20% reduction is applicable to physicians and physical therapists in private practice; the 25% reduction is applicable to other settings that bill for Part B services including CORFs, SNFs (Part B), home health (Part B), outpatient hospitals, and rehabilitation agencies. The CPT code with the highest practice expense value delivered on a given day on the same patient will be reimbursed at its full value. For the second and each subsequent code, the practice expense value will be reduced. Because clinicians who deliver therapy services typically deliver a variety of services as represented by the CPT codes, there are numerous potential code combinations that, when executed, determine the total reimbursement for services in a given day. The MPPR calculator spreadsheet is designed to help APTA members determine their reimbursement for services based on the MPPR policy only.
Access both calculators at this link.