March 20, 2026: Why MPPR Is Back in the Spotlight
In the world of therapy services, payment policy can feel far removed from day-to-day work with students and patients. But reimbursement rules directly affect whether providers can keep positions filled, maintain reasonable caseloads, and deliver consistent services.
That’s why the American Speech-Language-Hearing Association (ASHA)—along with a coalition of organizations representing therapy providers—is urging Congress to eliminate the Multiple Procedure Payment Reduction policy (MPPR). The coalition’s message is clear: MPPR is outdated, it reduces reimbursement for essential services (including speech therapy), and it threatens access to care.
What Is MPPR (Multiple Procedure Payment Reduction)?
MPPR is a payment policy that reduces reimbursement when multiple therapy services are provided to the same patient on the same day.
Here’s the basic idea under Medicare Part B:
- Medicare pays in full for the procedure with the highest “practice expense.”
- Then MPPR applies a 50% reduction to the practice expense portion of the second and any additional CPT codes billed that same day.
This policy applies broadly to therapy services—physical therapy (PT), occupational therapy (OT), and speech therapy (ST)—and it applies regardless of setting. Importantly, MPPR does not differentiate between therapy disciplines. If multiple services are provided in one day, the reduction is applied even when those services are clinically appropriate and necessary.
Why Does This Matter for Speech, OT, and PT?
On paper, MPPR might sound like a technical billing adjustment. In practice, it can create real-world pressure on therapy access.
When payment is reduced for “additional” services on the same day, it can:
- Make it harder for clinics and providers to sustain operations—especially in rural or high-need areas.
- Discourage efficient scheduling (for example, coordinating services on the same day to reduce travel and missed appointments).
- Increase financial strain on providers already navigating annual Medicare cuts.
- Ultimately limit patient access to needed speech-language pathology services, including speech, language, swallowing, and cognitive-communication supports.
ASHA President Linda Rosa-Lugo underscored the stakes, noting that MPPR-related payment reductions—combined with ongoing annual Medicare cuts—continue to jeopardize access to vital services for older Americans. She also emphasized a key point that often gets overlooked: therapy services can reduce overall health care costs by supporting function, safety, and independence.
The “Medicare Policy” Problem That Spreads Beyond Medicare
One of the most challenging parts of MPPR is that its influence doesn’t always stop with Medicare.
Other payers are not required to adopt MPPR. However, many have chosen to implement similar reductions—sometimes in ways that are even more severe.
For example:
- Medicare reduces the practice expense portion by 50% for the second and subsequent codes.
- Some other payers have applied the reduction to the full value of the CPT code.
That difference matters. Applying the cut to the full code value can create a larger payment decrease, compounding the impact of Medicare’s approach and adding additional strain to provider reimbursement.
How ASHA Is Responding
ASHA has been advocating against MPPR for years, and this effort has now intensified through coordinated action with other therapy organizations.
Recently, ASHA sent letters urging repeal of MPPR and broader reform of therapy payments under the Medicare Physician Fee Schedule. These letters were directed to leaders of:
- The Senate Finance Committee
- The House Energy and Commerce Committee
The goal is twofold:
- Eliminate MPPR as an outdated policy that reduces payment for necessary services.
- Modernize payment systems so therapy providers are reimbursed appropriately and beneficiaries can maintain access to care.
State-Level Advocacy: A Helpful Example From Colorado
While Medicare policy is federal, the ripple effects can show up in state-level payer systems, including Medicaid and other insurers. ASHA noted that some states have taken steps to prevent similar reductions by other payers.
Colorado is one example where state laws have been passed to prevent this type of reduction from being adopted by other payers such as Medicaid. Advocacy efforts there included collaboration among:
- The Colorado Speech-Language-Hearing Association
- ASHA
- The Colorado TriAlliance (ST/OT/PT)
This type of cross-discipline partnership is a reminder that payment policy affects the entire therapy ecosystem—and that coordinated advocacy can make a difference.
What’s Next: The Push to Repeal MPPR and Modernize Payment
ASHA has stated it will continue urging Congress to eliminate MPPR and modernize the Medicare Physician Fee Schedule. The central argument is straightforward: therapy providers should be paid appropriately for medically necessary services so patients can access the care they need.
In addition to MPPR repeal, ASHA is also encouraging advocacy related to another policy issue: the Efficiency Adjustment Delay Act. This legislation would prevent a 2.5% “efficiency adjustment” reduction to the value of certain CPT codes. ASHA’s concern is that this reduction compounds the harm of MPPR and other Medicare payment cuts.
Why This Matters to Schools and Teletherapy Partners Like TinyEYE
Even though MPPR is a Medicare Part B policy, reimbursement trends influence the broader therapy workforce. When provider reimbursement is reduced across settings, it can contribute to staffing instability and shortages—especially for specialized roles.
From a school district perspective, staffing shortages are not abstract. They show up as:
- Unfilled SLP/OT/PT positions
- Interrupted services
- Increased caseloads for existing staff
- Challenges meeting IEP service minutes consistently
That’s one reason school-based teletherapy has become an important part of the service continuum. Companies like TinyEYE help districts maintain access to qualified clinicians when local hiring is difficult, supporting continuity of services for students.
While school services and Medicare reimbursement operate in different systems, both depend on a stable therapy workforce. Policies that reduce the financial sustainability of therapy practice can indirectly affect the pipeline and availability of providers across the lifespan.
Questions and Official Contacts
ASHA has shared the following contacts for questions about this advocacy work:
- Josh Krantz, ASHA’s associate director of federal affairs, health care: jkrantz@asha.org
- Health Care Education and Policy team: reimbursement@asha.org
For more information, please follow this link.
