MPPR & RVUs: How Multiple Procedure Rules Change Your Pay

When you perform more than one service on the same patient, same day, payment and RVU math can change fast. Multiple Procedure Payment Reduction (MPPR) and related rules determine whether the second and subsequent codes get reduced—and whether that reduction hits work RVUs, practice expense, malpractice, or the overall allowed amount. This guide breaks it down with clean examples and the key modifiers you’ll actually use.

What Is MPPR?

MPPR is Medicare’s policy to reduce payment when multiple services are furnished to the same patient on the same day because certain costs (setup, room time, equipment, staff) overlap. Commercial payers often follow similar—but not identical—rules.

Key idea: MPPR doesn’t always reduce work RVUs. In some families (e.g., diagnostic imaging, therapy), MPPR primarily reduces the practice expense component. For multiple surgeries, different rules apply to the global surgical payment (often summarized as “100% / 50% / 50% / 50%…” for the highest through 5th procedure).

Where MPPR (and Look-Alike Rules) Apply

1) Multiple Surgeries (same session)

• Highest-valued procedure paid at 100% of the allowed amount.
• Second–fifth procedures typically reduced (often to 50% of the allowed amount). Sixth and beyond may have further payer/pricing rules.
• Endoscopy “family” rules and certain add-on codes follow separate logic.

Impact on RVUs: Practically, physicians track work RVUs to gauge productivity and comp, while payers adjudicate the full RVU package (work + practice expense + malpractice). Under multiple surgery rules, the reduction is on the payment for the additional procedures. Your contract may credit full wRVUs or reduced wRVUs—read it closely.

2) Diagnostic Imaging MPPR

• When multiple imaging procedures are done in the same session, practice expense on the second and subsequent imaging services is reduced (commonly 50%).
• Different reductions can apply to “professional” vs “technical” components if billed separately.

3) Therapy MPPR (PT/OT/SLP)

• Practice expense is reduced on the second and subsequent timed therapy units furnished on the same day for the same patient.
• Applies whether furnished by one therapist or multiple therapists within the same group (TIN).

MPPR vs. Work RVUs: What Actually Gets Reduced?

For many clinicians, the biggest question is: “Does MPPR reduce my work RVUs?” The answer is: it depends on the code set and your compensation policy.

• Multiple surgeries: Payers typically reduce the payment for additional procedures. Your wRVU credit can be full or reduced depending on your employment contract and internal policy.
• Imaging/Therapy MPPR: Reductions usually hit the practice expense portion. wRVUs may remain unchanged for those codes.

Best practice: Know how your organization credits wRVUs under MPPR/multiple procedures. Two groups with identical clinical work can show very different “productivity” if one credits full wRVUs and another credits reduced values.

The Modifiers That Matter

Worked Examples (Easy Math)

A) Multiple Surgeries, Same Session

Assume a conversion factor (CF) of $38.00 and the following total RVUs (for illustration):

B) Diagnostic Imaging MPPR

Suppose two imaging codes are performed in the same session. MPPR reduces the practice expense for the 2nd study (commonly 50%). If billed globally, you’ll see a smaller drop than if only technical is billed.

C) Bilateral Procedure (Modifier 50)

For a code with a bilateral indicator that allows 150% payment when performed bilaterally, many payers treat “one line with modifier 50” as 150% of the unilateral allowed amount. Some want RT/LT on two lines—follow payer guidance. Whether wRVUs are multiplied or credited once depends on your group’s policy.

Quick Reference: What Usually Gets Reduced?

Practical Tips to Protect Your Compensation

• Rank matters: Ensure the highest-valued procedure is primary so reductions apply to lower-valued lines.
• Use modifiers correctly: 51, 50, and 59 (or XS/XE/XP/XU) drive correct adjudication and avoid denials.
• Audit your wRVU policy: Confirm whether your group credits full or reduced wRVUs under MPPR and bilateral rules.
• Know the indicators: The MPFS multiple procedure and bilateral indicators tell you how a code behaves.
• Reconcile monthly: Compare your personal log to employer reports—MPPR errors are common and fixable.

Bring MPPR Math Into Your Daily Tracking

The easiest way to avoid surprises is to log procedures as you go—with modifiers—and compare against what your organization credits. RVU Tracker helps you capture multiple procedures, flag where MPPR or bilateral rules might apply, and see the impact on your goals in real time.