What is a MPPR?
The multiple procedure payment reduction (MPPR) means that if a healthcare provider performs multiple procedures during a single patient encounter, Medicare (and many commercial insurers) typically will pay “full price” for only the highest-valued procedure.
What is MPPR rate?
Medicare applies a multiple procedure payment reduction (MPPR) to the practice expense component of certain “always therapy” services. Since April 1, 2013, this MPPR rate is 50 percent for both practitioner/office and institutional settings.
What is MPPR therapy?
A reduction in reimbursement for Medicare Part B therapy is scheduled to take place for services incurred on and after January 1, 2011. This reduction is part of a policy called the Multiple Procedure Payment Reduction policy (MPPR) and was a result of the Physician Payment and Therapy Relief Act of 2010 (H.R.
How much is the MPPR reduction?
The MPPR policy implements a 50% payment reduction to the practice expense value of certain CPT codes deemed “always therapy services.”
How does MPPR affect occupational therapy?
MPPR reduces the reimbursement for any subsequent unit of service performed after the first unit for a given code and decreases the practice expense component of the code by 50%. Not all services will receive an MPPR, but some labeled “always therapy” services will.
How are multiple procedures paid?
When health care providers perform multiple procedures during a single patient encounter, Medicare (and many commercial insurers) typically pay “full price” for only the highest-valued procedure.
What are always therapy codes?
According to CMS, certain codes are ‘Always Therapy’ services no matter who performs them and require a therapy modifier (GP, GO, or GN) to indicate they are provided under physical therapy, occupational therapy, or speech-language pathology plan of care.
What is multiple therapy reduction?
The multiple therapy procedure reduction applies when more than one procedure or more than one unit of the same procedure, from the Multiple Therapy Reducible Codes list is provided to the same patient on the same day, i.e., the reduction applies to multiple units as well as to multiple procedures.
How do you bill for surgery?
If you provide the typical postoperative care instead of the surgeon, you should bill your services by appending modifier -55, “Postoperative management only,” to the code for the surgical procedure. Using the hip replacement example above, you would bill your postoperative services using 27130-55.
Are add on codes paid at 100%?
Type I add-on codes are never paid unless a listed primary procedure code is also paid. See CMS Pub-100-04, Chapter 12, Section 30.6. 12(I). According to CMS, the add-on codes are in three groups to distinguish the payment policy for each group.
What are GN go and GP modifiers?
Modifiers GN, GO, and GP refer only to services provided under plans of care for physical therapy, occupational therapy and speech-language pathology services. They should never be used with codes that are not on the list of applicable therapy services.
What is modifier CQ?
The modifiers are defined as follows: CQ modifier: Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant. CO modifier: Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant.