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 2020 MPPR calculator incorporates the 50% 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 2020 payment rate with the 2019 payment rate. The 2020 calculator also includes these features:
- Participating vs nonparticipating provider fee calculations.
- 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 2020 calculator, the "Without Sequestration/MIPS" amount with the 50% MPPR applied is the maximum amount the nonparticipating provider can collect from the beneficiary.
- MIPS adjustment factor. This is not applicable to PTs in 2020; please maintain the adjustment amount at 0% for all calculations.
Download the 2020 MPPR Calculator (.xls) | Download Calculator FAQs (.pdf)
The 2019 MPPR calculator incorporates the 50% 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. The calculator also includes the features in the 2020 calculator (discussed above).
Download the 2019 MPPR Calculator (.xls) | Download Calculator FAQs (.pdf)
CMS Fee Schedule Calculator
Access the CMS Medicare Physician Fee Schedule Calculator
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