Therapy Multiple Procedure Payment Reduction (MPPR) Estimator
Since April 2013 Medicare pays the highest practice-expense unit in full and halves only the practice-expense component of every later same-day therapy unit. Enter each unit's allowed amount and its PE dollars to see the real adjusted total.
How CMS Applies the Therapy MPPR (and What It Never Touches)
Per the CMS Therapy Services CY 2026 update and Noridian JE's MPPR article: the reduction is 50% of the practice-expense component only, applied to the second and subsequent always-therapy services for the same patient on the same day, across disciplines and across professional/institutional claims. The unit with the highest PE is paid in full; physician work and malpractice components are never reduced. Get each unit's PE dollars from the MPFS Relative Value File (PE RVU × conversion factor) or your fee-schedule lookup, then run the worksheet.
KX modifier threshold: have you crossed $2,480 this year?
For CY 2026 the KX threshold is $2,480 for PT and SLP combined and $2,480 separately for OT (CMS Therapy Services CY 2026 update; re-confirmed at each November re-check). Crossing it is not a cap and not permission: append KX only on claims where continued therapy is medically necessary and the record documents it. The year-to-date fields in the allocator above run this check on every calculation.
Frequently Asked Billing Questions
Does MPPR reduce the whole allowed amount of the second unit by 50%?
No. Only the practice-expense slice is halved. On a typical timed unit that is roughly a fifth to a third of the allowed amount, so the real reduction is far smaller than billers fear - this worksheet shows the exact figure.
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