What is a Multiple Procedure Payment Reduction  in Medical Billing?

It’s no secret that Medical Billing can be complicated, especially if your medical practice works with Medicare patients.

One area of confusion can be the Multiple Procedure Payment Reduction (MPPR) and how it works.

When a physician performs multiple (two or more) procedures, that are related, during the same session, Medicare won’t pay 100% of the fee schedule amount.


The MPPR is a pay-rate scale in which the first procedure is paid at 100 percent of contractual allowance, while the second may be paid at a reduced rate (often 50 percent for up to five), and the third at whatever percentage is deemed appropriate per the contract.

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.

Some commercial companies will impose a Multiple Procedure Payment Reduction in some instances. However they may have different rules. 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 that are eligible for reimbursement.

Because of this, when doing the medical billing for your physicians services, 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.

As many insurance companies use different MPPR rules, before signing a managed care contract, the practice should be fully aware of their MPPR policy. 

It may 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.