Independence Blue Cross and Independence Administrators are updating their claim payment policy on multiple procedure payment reduction (MPPR) for Physical, Occupational, and Speech Therapy Services, effective July 1, 2024.
The new version of the policy aligns our reimbursement position with the Centers for Medicare & Medicaid Services (CMS) MPPR guidelines for Physical, Occupational, and Speech Therapy Services (i.e., Always Therapy services). Our reimbursement position has been revised from applying MPPR at the procedure code level only to include the procedure code or units of service.
The hierarchy for MPPR guidelines is set forth below:
- 100 percent of the facility provider's applicable contracted rate of one unit of the procedure code with the highest total allowance is eligible for reimbursement consideration.
- Each subsequent unit or procedure code is eligible for reimbursement at 50 percent of the provider's applicable contracted rate.
As we continue to move to a new claims processing platform, the way this policy change is applied may vary based on the claims processing platform. Additional information will be provided in a future article.
View the policy notifications that were posted on May 31, 2024, to learn more. Note that these links will expire once the policies go into effect on July 1, 2024.
To access the most updated version of any active policy, please refer to the Medical Policy Portal or simply navigate to the Commercial or Medicare Advantage policy bulletins.