The multiple procedure payment reduction (MPPR) policy implements a 50% payment reduction to the practice expense value of certain CPT codes deemed "always therapy services." The reduction is applicable to physicians and physical therapists in private practice, CORFs, SNFs (Part B), home health (Part B), outpatient hospitals, and rehabilitation agencies. 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.
Outpatient Therapy Claim Pricer (MPPR Calculator)
These outpatient therapy claim pricer (MPPR Calculator) spreadsheets are designed to help you determine your payment for services.
The 2019 MPPR calculator incorporates the 50% multiple procedural payment reduction (MPPR) for values under the Medicare physician fee schedule, and applies the overall 2% sequestration cut on Medicare payments. It also allows you to compare the 2019 payment rate with the 2018 payment rate. In addition to the normal fee schedule updates, the 2019 calculator includes these features:
- Addition of participating vs nonparticipating provider fee calculations. These calculations are for 2019 rates only and not for historical 2018 rates; keep that in mind when comparing rates between 2019 and 2018.
- Nonparticipating providers may choose to accept assignment, and therefore receive reimbursement directly from Medicare, on a claim-by-claim basis. For all assignments that a nonparticipating provider accepts, Medicare reimbursement is 5% less than what participating providers receive.
- For services for which nonparticipating providers do not accept assignment, the limiting charge is 115% of the nonparticipating fee schedule amount. In the 2019 calculator, the "Without Sequestration/MIPS" amount with the 50% MPPR applied is the maximum amount the nonparticipating provider can collect from the beneficiary.
- Addition of MIPS adjustment factor. This is not applicable to PTs in 2019; please maintain the adjustment amount at 0% for all calculations.
Download the 2019 MPPR Calculator (.xls) | Download Calculator FAQs (.pdf)
This is the 2018 MPPR calculator that illustrates the 50% reduction due to the multiple procedural payment reduction for values under the Medicare Physician Fee Schedule, as well as application of the overall 2% sequestration cut on Medicare payments. It also allows you to compare the 2018 payment rate to the 2017 payment.
Download the 2018 MPPR Calculator (.xls) | Download Calculator Instructions (.pdf)
CMS Fee Schedule Calculator
Access the CMS Medicare Physician Fee Schedule Calculator
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