Medicare Payment Cuts Threaten Rehab Therapy Access
A coalition of healthcare organizations, led by the American Physical Therapy Association (APTA), is urgently calling on Congress to address the Multiple Procedure Payment Reduction (MPPR) policy, warning it jeopardizes access to vital rehabilitation services. The MPPR, initially implemented in 2011, applies to physical therapy, occupational therapy, and speech-language pathology services under Medicare Part B.
What is the MPPR and Why is it a Problem?
The MPPR penalizes therapists when multiple “always therapy” services are provided to a patient during the same day. Specifically, the practice expense component of each additional unit is reduced by 50%. This reduction, representing roughly 45% of a code’s value, significantly undervalues these essential services. The policy was originally intended as a short-term budgetary measure, but remains in effect.
Impact on Patients and Providers
Advocates argue the MPPR discourages efficient, coordinated care. For patients with complex conditions, or those in rural areas with limited access to transportation, receiving multiple therapy services in a single session can be crucial. The MPPR creates financial instability for therapy providers, potentially leading to clinic closures and reduced access to care, particularly in underserved communities.
APTA President Kyle Covington stated, “MPPR was never designed for the realities of interdisciplinary therapy. It discourages efficient care delivery…and ultimately risks delaying recovery for Medicare beneficiaries.”
The Broader Context: Ongoing Payment Pressures
The MPPR isn’t occurring in isolation. Rehabilitation providers are also facing other payment pressures, including a 15% reduction in payments for services delivered by therapy assistants and cumulative annual cuts to the physician fee schedule since 2020. These combined challenges are making it increasingly difficult for clinics, especially smaller and rural practices, to remain financially viable.
Industry Response and Calls for Reform
Organizations like the American Occupational Therapy Association (AOTA) and the American Speech-Language-Hearing Association (ASHA) have joined the APTA in urging Congress to act. AOTA CEO Katie Jordan commented, “MPPR cuts payment for therapy simply because a beneficiary receives more than one 15-minute unit of service in a day…repealing the MPPR has to be part of the answer.” ASHA echoed these concerns, highlighting the potential impact on access to speech, language, and cognitive-communication services for seniors.
What’s Changing in 2026?
While the core MPPR policy remains under scrutiny, some updates are being implemented for the 2026 Medicare therapy services. The KX modifier threshold amount is $2,480. Three novel codes (98979, 98984, and 98985) for remote therapeutic monitoring (RTM) services have been added as “sometimes therapy” services. Telehealth services, including telephone assessment and management (codes 98966 – 98968), have been extended through December 31, 2027.
Looking Ahead: Potential Future Trends
The current pressure on the MPPR policy suggests a growing awareness of its detrimental effects. Several potential trends could emerge:
- Increased Congressional Scrutiny: The unified voice of provider organizations may lead to increased legislative attention and potential repeal efforts.
- Shift Towards Value-Based Care: A broader move towards value-based care models could incentivize coordinated, comprehensive therapy services, potentially mitigating the negative impacts of MPPR.
- Expansion of Telehealth: Continued expansion of telehealth and RTM services could offer alternative care delivery models, reducing the reliance on in-person visits and potentially circumventing MPPR limitations.
- Advocacy for Accurate Valuation: Ongoing advocacy efforts will likely focus on ensuring that Medicare reimbursement rates accurately reflect the value and complexity of rehabilitation services.
FAQ
What is the KX modifier? The KX modifier is used to indicate that a patient meets certain medical necessity requirements for therapy services.
What are “always therapy” codes? These are services that are typically billed as part of a comprehensive therapy plan of care.
What is RTM? Remote Therapeutic Monitoring (RTM) involves using technology to monitor a patient’s progress remotely.
When does the telehealth extension expire? The current extension for telehealth services expires on December 31, 2027.
Did you know? The MPPR policy has been in effect since 2013, impacting Medicare reimbursements for therapy services for over a decade.
Pro Tip: Stay informed about changes to Medicare billing policies by regularly visiting the CMS Therapy Services webpage.
Have questions about the MPPR or Medicare therapy benefits? Share your thoughts in the comments below!
