By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    improving patient experience
    6 Ways to Improve Patient Satisfaction Within Hospitals
    December 1, 2021
    degree for healthcare job
    What Are The Health Benefits Of Having A Degree?
    March 9, 2022
    custom software development is changing healthcare
    Digital Customer Journey Mapping and its Importance for Healthcare
    July 21, 2022
    Latest News
    Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
    May 16, 2025
    Learn how to Renew your Medical Card in West Virginia
    May 16, 2025
    Choosing the Right Supplement Manufacturer for Your Brand
    May 1, 2025
    Engineering Temporary Hospitals for Extreme Weather
    April 24, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Can Thinking Younger Make You Live Longer?
    April 20, 2011
    Image
    Obesity’s Outlook Unchanged
    June 13, 2011
    When It’s An Emergency Elderly Not Treated As Well in Hospitals
    July 16, 2011
    Latest News
    Building Smarter Care Teams: Aligning Roles, Structure, and Clinical Expertise
    May 18, 2025
    The Critical Role of Healthcare in Personal Injury Recovery: A Comprehensive Guide for Victims
    May 14, 2025
    The Backbone of Successful Trials: Clinical Data Management
    April 28, 2025
    Advancing Your Healthcare Career through Education and Specialization
    April 16, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Multiple Procedure Payment Reduction (MPPR): The Basics
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Business > Finance > Multiple Procedure Payment Reduction (MPPR): The Basics
BusinessFinanceHospital Administration

Multiple Procedure Payment Reduction (MPPR): The Basics

Andy Salmen
Last updated: August 1, 2013 8:11 am
Andy Salmen
Share
5 Min Read
MPPR: The Basics
SHARE

MPPR: The BasicsPhysician billing can be complicated, especially if you work with Medicare.  But even commercial companies impose a Multiple Procedure Payment Reduction, or MPPR, in some instances.

MPPR: The BasicsPhysician billing can be complicated, especially if you work with Medicare.  But even commercial companies impose a Multiple Procedure Payment Reduction, or MPPR, in some instances.  Here at Healthcare Information Services, we want to make sure that you understand this insurance procedure, and why it occurs.

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 payor 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.

More Read

Expertise and Exposure: Tips for Successfully Marketing a Medical Practice
5 Places Medical Practices Can Get Involved with Community Outreach
Important Considerations when Starting a Healthcare Business
Expansion of Medicare Rewards Adds Key Tool to Drive Behavior Change
Can “Portfolio Theory” Be Applied to NIH Funding Decisions?

Non-Medicare payors may have different rules when they apply MPPR.  For example, some commercial insurance companies only pay 50% for the first additional procedure, and 25% for each additional procedure after two.  They may also have different limits to the number of procedures that may be done in one session, for reimbursement.

There are some exceptions to MPPR.  For example, Medicare has a separate set of rules for endoscopy procedures.  But MPPR does not apply to evaluation and management or physical medicine and rehabilitation services.  It also cannot be used in order to reduce payment for supplies.

Modifier 51 should not be used for “add-on” codes, or procedures found in Appendix D of the CPT manual.  Any code listed with a “+” preceding it is not subject to MPPR.  There are also “modifier 51 exempt” procedures, which can be found in Appendix E.  These codes are listed with a circle with a slash through it preceding the code.  A good rule of thumb for figuring out when to not use modifier 51 is that any procedure that includes the phrase “each additional” in the code description should be exempt.

Keep in mind, though, that MPPR does apply to office procedures like injections.  Physician billing can get tricky when trying to report and calculate reimbursement for patients requiring injections in multiple sites, or injections and other treatments.

Before doing any physician billing, it’s very important to understand MPPR.  Some insurance companies will tell physicians not to use the 51 modifier when submitting their billing, as the payor will apply the discount, however many medical societies recommend that practices append the modifier anyway, making sure that it is appropriate.

As many insurance companies use different MPPR rules, before signing a managed care contract, the practice should be fully aware of their MPPR policy.  MPPR makes sense, considering the physician uses less resources to perform multiple procedures in one session, and only one global period applies, but a physician needs to be comfortable with the discount before signing a managed care contract. It’s also a good idea to consider using MPPR internally for self-pay patients, as it maintains consistency and makes healthcare more affordable, without cutting too far into the cost of running a practice. 

(Image courtesy of: photostock / Freedigitalphotos.net)

TAGGED:MPPRphysician billing
Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

Clinical Expertise
Building Smarter Care Teams: Aligning Roles, Structure, and Clinical Expertise
Health care
May 18, 2025
Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
Health
May 15, 2025
Learn how to Renew your Medical Card in West Virginia
Learn how to Renew your Medical Card in West Virginia
Health
May 15, 2025
Dr. Klaus Rentrop Shares Acute Myocardial Infarction heart treatment
Dr. Klaus Rentrop Shares Acute Myocardial Infarction
Cardiology
May 13, 2025

You Might also Like

Impact Investing in India

April 1, 2012
BusinessPublic Health

Better Patient Satisfaction – Which Model to Follow?

May 28, 2012
green hospitals
Hospital Administration

9 Hospitals That Have Introduced Green Initiatives

January 20, 2023
mobile email
BusinessSocial Media

10 Ways to Perfect Your Email Marketing

August 21, 2015
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?