Others titles
- CPT Physical Multiple Procedure Payment Reduction
- CMS Fee Multiple-Procedure-Payment-Reduction
Keywords
- Medicare Fee
- MPPR Payment Caps
- MPPR Therapy Services
- Medical RVUs
- Medicare Fee Multiple Procedure Payment Reduction
- MPPR Multiple-Procedure-Payment-Reduction
Multiple Procedure Payment Reduction

This dataset shows the therapy payment amount reduced by MPPR (Multiple Procedure Payment Reduction) is applied toward the therapy caps. MPPR amount may increase the amount of medically necessary therapy services the beneficiary receives before exceeding the therapy caps. Medicare is applying MPPR to the non-facility Practice Expense (PE) payment of select therapy services paid under the Medicare Physician Fee Schedule (MPFS).
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Description
The basic idea behind MPPR is that when a physician performs multiple (two or more) procedures, that are related, during the same session, Medicare and some commercial insurance companies won’t pay 100% of the fee schedule amount. Medicare allows 100% of the fee schedule amount for the first procedure reported, then 50% for the other procedures, up to five. If a physician performs more than five procedures in one session, when doing the physician billing, an operative report must be filed and Medicare will decide if additional reimbursement is allowed. Because of this, when doing physician billing, the highest value procedure should be listed first, then followed by the other procedures by value, with modifier 51 attached. Generally, the full value of each service should be listed and the payer will apply the MPPR. Most Medicare carriers do not require that modifier 51 be used for claims submitted to them. They will apply MPPR according to their RVU values for the procedures performed. The reduction applies to the Healthcare Common Procedure Coding System (HCPCS) codes contained on the list of “always therapy” services that are paid under the MPFS.
About this Dataset
Data Info
Date Created | 2016-01-01 |
---|---|
Last Modified | 2023-03-16 |
Version | 2023-03-16 |
Update Frequency |
Annual |
Temporal Coverage |
2022-2023 |
Spatial Coverage |
United States |
Source | John Snow Labs; Centers for Medicare and Medicaid Services; |
Source License URL | |
Source License Requirements |
N/A |
Source Citation |
N/A |
Keywords | Medicare Fee, MPPR Payment Caps, MPPR Therapy Services, Medical RVUs, Medicare Fee Multiple Procedure Payment Reduction, MPPR Multiple-Procedure-Payment-Reduction |
Other Titles | CPT Physical Multiple Procedure Payment Reduction, CMS Fee Multiple-Procedure-Payment-Reduction |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
Year | Calender year of the report. | date | - |
HCPCS_CodeFee_Amount | HCPCS number for the service. | string | - |
Short_Descriptor | Shortened, fixed-length description of the code | string | - |
Carrier | A number assigned to a specific Carrier | integer | level : Nominal |
Locality | A number assigned to a specific locality | integer | level : Nominal |
Fee_Amount | Payment amount | number | - |
Reduction_50percentage | 50% reductions amounts | number | - |
Practice_Expense_RVUs | Relative Value Unit (RVU) for the resource-based practice expense for CY 2022 and 2023. | number | level : Ratio |
Data Preview
Year | HCPCS Code | Short Descriptor | Carrier | Locality | Fee Amount | Reduction 50 Percentage | Practice Expense RVUs |
2023 | G0281 | Elec stim unattend for press | 1112 | 5 | 14.67 | 10.71 | 0.17 |
2023 | G0281 | Elec stim unattend for press | 1112 | 6 | 14.67 | 10.71 | 0.17 |
2023 | G0281 | Elec stim unattend for press | 1112 | 7 | 14.67 | 10.71 | 0.17 |
2023 | G0281 | Elec stim unattend for press | 1112 | 9 | 14.96 | 10.9 | 0.17 |
2023 | G0281 | Elec stim unattend for press | 1112 | 51 | 13.87 | 10.23 | 0.17 |
2023 | G0281 | Elec stim unattend for press | 1112 | 52 | 14.68 | 10.72 | 0.17 |
2023 | G0281 | Elec stim unattend for press | 1112 | 53 | 13.86 | 10.22 | 0.17 |
2023 | G0281 | Elec stim unattend for press | 1112 | 54 | 12.72 | 9.61 | 0.17 |
2023 | G0281 | Elec stim unattend for press | 1112 | 55 | 12.64 | 9.53 | 0.17 |
2023 | G0281 | Elec stim unattend for press | 1112 | 56 | 12.64 | 9.53 | 0.17 |