With numerous multiple procedural payment reduction (MPPR) policies in effect, it is important for physical therapists to understand the methodology each payer uses in determining payment. Aetna's methodology for the application of its MPPR policy varies slightly from the policy adopted by the Centers for Medicare and Medicaid Services (CMS). CMS has only 1 payment rate and payment structure in a given geographic area, while Aetna may have several different types of payment structures in the same area. Therefore, Aetna is unable to efficiently apply the exact CMS calculations to arrive at a final payment amount.
Aetna bases its reduction for the second and subsequent therapy services on the contribution of the practice expense relative value unit (RVU) to the total RVUs for a given procedure. Aetna, unlike CMS, does not use geographic practice cost indexes (GPCIs) in calculating its reduction. An example of Aetna's methodology can be found here.
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