Humana Resumes MPPR Policy

According to a recent release by the APTA, Humana has restarted its multiple procedure payment reduction (MPPR) policy that applies to Medicare Advantage and commercial insurance plans.  The policy, which Humana had temporarily ceased back in January, was reinstated for non-facility providers as of October 29th, per the APTA’s update.  Humana’s MPPR policy uses the same formula as Medicare in that the CPT code with the highest practice expense portion of the RVU is paid at 100% and then subsequent CPT codes billed on that date of service are reduced by a factor of 50% of the practice expense portion of the RVU.

As you may recall, Humana has see-sawed on its implementation of an MPPR policy over the last few years.  After initially implementing an MPPR policy without advanced notification of providers in early 2011, Humana reversed its policy later that year.  Humana implemented an MPPR policy for its Medicare Advantage plans in 2012 and for its commercial plans in 2013 and then pursued overpayments retroactively beginning in the summer of 2013.  Humana once again put the policy on hold in January of 2014 in order to reevaluate the policy’s implementation.

With the recent restart of its MPPR policy, Humana has joined United Healthcare (Medicare Advantage plans) and Aetna as well as several regional insurance carriers as payors who have followed in CMS’s footsteps by implementing an MPPR policy for therapy services.