Multiple Procedure Payment Reduction
A Multiple procedure payment reduction is a policy where reimbursement for additional surgical or diagnostic procedures performed on the same patient during the same session is reduced.
What is a Multiple Procedure Payment Reduction?
Multiple procedure payment reduction is a Centers for Medicare and Medicaid Services (CMS) reimbursement policy that applies when multiple diagnostic imaging services, therapy services, or surgical procedures are administered to the same patient on a single day. This policy aims to reduce the overall payment for these multiple services by applying a reduction to the payment of subsequent procedures after the primary one.
This reduction can apply across different medical disciplines and practice settings, including physical therapy, occupational therapy, and speech-language pathology. The intention behind the multiple procedure payment reduction is to account for the overlapping costs that may occur when multiple services are performed in the same session or on the same day by the same physician or qualified healthcare professional, such as the initial setup or administrative costs.
What is the difference between a Multiple Procedure Payment Reduction and Bundled Payments?
Multiple procedure payment reduction (MPPR) is a CMS policy that reduces payment for subsequent procedures when multiple services are provided to the same patient on a single day, accounting for overlapping costs. Bundled payments, in contrast, group multiple services into a single payment, aiming for cost efficiency and improved care coordination over an episode of care or a defined period.
Multiple procedure payment reduction applies to individual services performed on the same day to the same patient to reduce overlapping costs.
Bundled Payments combine payments for multiple services, typically for an episode of care or a defined period, encouraging coordination.
MPPR reduces payment for subsequent procedures after the primary one.
Bundled Payments involve a single, predetermined payment for all services related to a specific condition or treatment.
MPPR focuses on individual service cost reduction, while bundled payments focus on overall episode cost efficiency and quality.
What are examples of a Multiple Procedure Payment Reduction?
A patient receives an MRI of the brain, a CTA, and a CT of the head on the same day. The MRI will be reimbursed at 100%, but the CTA and CT of the head will have reduced reimbursement (e.g., technical component by 50% and professional component by 25%) due to MPPR.
A patient receives two surgical procedures on the same day by the same surgeon. The primary, most expensive procedure is paid at 100% of the Medicare Physician Fee Schedule amount, while the secondary procedure's payment is reduced, often to 50% of its usual amount, to account for shared costs like surgical setup.
A patient undergoes physical therapy and occupational therapy in the same session. Instead of paying both services at 100%, the MPPR policy applies a reduction to the less expensive service to reflect that some initial administrative or setup costs are not duplicated.
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