In a pair of letters to the leadership of the Senate Finance and House Energy and Commerce panels, a coalition of therapy profession stakeholders urged the lawmakers to repeal “the outdated and flawed policy known as the Multiple Procedure Payment Reduction Policy, or MPPR,” as part of any reforms to the Medicare Physician Fee Schedule.

The organizations in the coalition said they have opposed MPPR since it was first implemented in 2011.

“This obsolete policy—originally enacted as a short-term ‘pay for’ by Congress more than 15 years ago— applies to physical therapy, PT, occupational therapy, OT, and speech-language pathology, SLP, services provided under Medicare Part B,” the letters said.

The three professions are recognized in the Medicare statute and governed by distinct scopes of practice under state licensure.

The letters said under MPPR, when an office-based therapist or facility-based provider bills more than one “always therapy” service, identified by CPT code, on the same day for the same patient, all therapy services beyond the first service unit are subject to a 50 percent reduction in the practice expense portion, including subsequent units of the same service and any additional service codes billed.

“The practice expense portion accounts for approximately 45 percent of a CPT code’s value. The reduction percentage applied under MPPR was arbitrarily decided by the 112th Congress and does not reflect actual utilization data, such as how many units of a therapy service are typically delivered during a treatment session or which practice expense inputs might truly be duplicative,” the letters said.

Further, the MPPR policy does not recognize that OT, PT, and SLP interventions are separate and distinct from one another.

MPPR Dissuades Beneficiary Services

At its core, MPPR discourages services that help Medicare beneficiaries remain independent, the letters said. “Rehabilitation services are often delivered through coordinated, interdisciplinary treatment plans designed to restore function, prevent disability, and allow patients to remain independent in their homes and communities,” the coalition said. “The MPPR policy undermines these goals by discouraging the efficient delivery of multiple therapy disciplines on the same day and creating financial disincentives for coordinated care.”

With the Medicare program increasing its emphasis on value-based care, care coordination, and improved patient outcomes, the MPPR policies are inconsistent with these objectives, the letters said.

“In addition, the combination of the MPPR policy, the recent 15 percent cut to services provided by therapy assistants, and the 9 percent cumulative cut to therapy services since 2020 caused by the E&M policy under the Medicare Fee Schedule has made it unsustainable for many providers to keep their clinics open,” thus affecting beneficiary access to care.

Among the coalition members are the Alliance for Physical Therapy Quality and Innovation, American Health Care Association/National Center for Assisted Living, and American Physical Therapy Association.

Comments? Contact Patrick Connole at pconnole@parkplacelive.com.