This video in daisyBill’s Essential Basics Explained series provides information on Multiple Procedure Payment Reductions (MPPR) for services rendered by providers in the same day.

Video Summary

This video in daisyBill’s Essential Basics Explained series demystifies Multiple Procedure Payment Reductions (MPPR) for services rendered by providers in the same day. Learn all about the applicability of MPPRs and the regulations that govern them within the Physician Services fee schedule. The video covers MPPRs and how they affect workers’ comp reimbursements in California.

Table of Contents

Multiple Procedure Payment Reduction (MPPR)

1. “Always Therapy” Codes

2. Time-based Therapy Codes

3. Therapy Services Furnished by a Group

4. Multiple Procedure Value of “5” + Selected Codes

Update Table

National Physician Fee Schedule Relative Value File:

Reimbursement Caps Apply to Services Provided in a Single Visit

California Code of Regulations (CCR)

Division of Workers’ Compensation Websites

Multiple Procedure Payment Reduction (MPPR)

Multiple Procedure Payment Reductions (MPPR) apply to services delivered in a single location on the same day. MPPRs apply to a variety of situations that fall into four general categories for physical medicine:

1. “Always Therapy” Codes
2. Time-based Therapy Codes
3. Therapy Services Furnished by a Group
4. Multiple Procedure Value of “5” as well as Selected Codes

1. “Always Therapy” Codes

MPPR applies when more than one Medicare “Always Therapy” code is billed on the same day.

The list of "Always Therapy" codes can be found in the Update Table of the Physician Services fee schedule:

2. Time-based Therapy Codes

MPPR apply to time-based codes which are billed with multiple units. Full payment is made for the procedure with the highest ‘practice expense’ (PE) RVU component and reduced payment applies to the subsequent codes.

3. Therapy Services Furnished by a Group

MPPR applies if other therapy services are provided by another practitioner within the same group practice: this includes physical therapy, occupational therapy, and speech-language pathology.

4. Multiple Procedure Value of “5” + Selected Codes

MPPR also apply to procedures with a multiple procedure value of “5” on the National Physician Fee Schedule Relative Value File (RVU) or those with codes 98940, 98941, 98942, and 98943.

Update Table

Any updates to the Physician Services Fee Schedule can be found on the § 9789.19. Update Table. This table is updated frequently, so be sure to check it periodically or stay up-to-date by subscribing to daisyBill’s email list.

National Physician Fee Schedule Relative Value File:

The Relative Value File file contains updated relative value units (RVUs), fee schedule status indicators, and payment policy indicators for services covered in the Physician Services fee schedule. The most recent files are the 2019 RVUA file, updated 12/20/2018, and the 2019 RVUB file for release in April 2019.

Reimbursement Caps Apply to Services Provided in a Single Visit

In addition to the MPPR, the following caps are presumed reasonable limitations on reimbursement for services provided at one visit.

• For physical medicine modalities: no more than two codes per visit
• For physical medicine modalities: no more than 60 minutes per visit
• When modalities & procedures are billed together: no more than 4 codes per visit

Definitions:  

Modality: a service that is listed in the CPT Medicine section, Physical Medicine and Rehabilitation under the sub-heading of “Modalities”

Procedure: a service that is listed in the CPT Medicine section, Physical Medicine and Rehabilitation under the sub-headings “Therapeutic Procedures” and “Other Procedures” and the headings “Acupuncture” and “Chiropractic Manipulative Treatment”

These caps apply unless a pre-authorized and pre-negotiated fee agreement has been arranged and memorialized in writing.

California Code of Regulations (CCR)

§ 9789.15.4 Physical Medicine / Chiropractic / Acupuncture Multiple Procedure Payment Reduction; Pre-Authorization for Specified Procedure/Modality Services

Division of Workers’ Compensation Websites

Official Medical Fee Schedule

Physician Services Fee Schedule

Physician Services Fee Schedule Update Table

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