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

2020-01-30

Version

2020-01-30

Update Frequency

Annual

Temporal Coverage

2018 to 2020

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
YearCalender year of the report.date-
HCPCS_CODEHCPCS number for the service.string-
SHORT_DESCRIPTORShortened, fixed-length description of the codestring-
CARRIERA number assigned to a specific Carrierintegerlevel : Nominal
LOCALITYA number assigned to a specific localityintegerlevel : Nominal
FEE_AMOUNT_USDPayment amountnumber-
Reduction_50percentage_USD50% reductions amountsnumber-
PRACTICE_EXPENSE_RVUsRelative Value Unit (RVU) for the resource-based practice expense for CY 2016.numberlevel : Ratio

Data Preview

YearHCPCS CODESHORT DESCRIPTORCARRIERLOCALITYFEE AMOUNT USDReduction 50percentage USDPRACTICE EXPENSE RVUs
2018G0281Elec stim unattend for press1112518130
2018G0281Elec stim unattend for press1112618130
2018G0281Elec stim unattend for press1112718130
2018G0281Elec stim unattend for press1112918130
2018G0281Elec stim unattend for press11125117120
2018G0281Elec stim unattend for press11125218120
2018G0281Elec stim unattend for press11125317120
2018G0281Elec stim unattend for press11125416110
2018G0281Elec stim unattend for press11125516110
2018G0281Elec stim unattend for press11125616110