The Medicare Annual Therapy Dollar Threshold and MPPR

Video Runtime: 41 Minutes; Learning Assessment Time: 22 Minutes

Therapists and assistants often do not understand the Medicare annual therapy dollar threshold, how it is calculated, and when to use the KX modifier. In addition, they do not understand the Multiple Procedure Payment Reduction (MPPR) policy.

This course will teach participants about the Medicare annual therapy dollar threshold and the targeted medical review process. In addition, this course will teach participants the MPPR and its impact on payment, its effect on the annual therapy cap dollar threshold, and how payment is reduced when a Medicare beneficiary is seen by one, two, or all three disciplines on the same date of service.

Learning Objectives

• List which settings the Medicare annual therapy dollar threshold applies to
• Conclude the annual therapy dollar threshold and targeted medical review threshold amounts and what amount counts toward the annual therapy dollar threshold
• Name the criteria that is used to select claims that have exceeded the targeted medical review dollar threshold
• Conclude which relative value unit the Multiple Procedure Payment Reduction (MPPR) policy impacts
• Recognize the claim adjustment reason code identifying the MPPR
• Recall the percent reduction of the practice expense relative value unit under MPPR