As previously communicated, AmeriHealth HMO, Inc., AmeriHealth Insurance Company of New Jersey, and AmeriHealth Administrators updated their claim payment policy on multiple procedure payment reduction (MPPR) for Physical, Occupational, and Speech Therapy Services (i.e., Always Therapy services). The update was effective July 1, 2024.
The new version of the policy aligns our reimbursement position with the Centers for Medicare & Medicaid Services (CMS) MPPR guidelines for Always Therapy services. Our reimbursement position was revised from applying MPPR at the procedure code level only to include the procedure code or units of service.
The way the updated policy is applied may vary based on the claims processing platform used. See examples below.
- For claims processed on the existing platform:
| Claim | Date of Service | CPT® Always Therapy Code | Units of Service (UOS) | Allowed Amount per UOS | Total Allowed Amount | MPPR Percentage | Paid Amount |
| Line 1 | 6/1/2023 | 92521
| 3 units | $100.00 | $300.00 | 100% | $300.00 |
| Line 2 | 6/1/2023 | 92523 | 2 units | $75.00 | $150.00 | 50% | $75.00 |
- For claims processed on the new platform:
| Claim | Date of Service | CPT Always Therapy Code | Units of Service (UOS) | Allowed Amount per UOS | Total Allowed Amount | MPPR Percentage | Paid Amount |
| Line 1 | 7/1/2024 | 92521 | 3 units
| $100.00 | $300.00 | 1st unit 100%; remaining units 50% | $200.00 |
| Line 2 | 7/1/2024 | 92523
| 2 units
| $75.00 | $150.00 | 50% | $75.00 |
For more information on this policy change, review the Updates to MPPR Always Therapy Policy FAQ.
Visit our dedicated Platform Transition page to stay informed of our ongoing platform transition.
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