Updated regulations for Therapy Multiple Payment Procedure Reduction
What is changing?
Effective February 1, 2026, CareOregon is aligning with policies established in 2014 by Centers for Medicare and Medicaid Services (CMS) to apply the Multiple Procedure Payment Reduction (MPPR) to selected therapy services performed on the same day. This will affect physical, speech, and occupational therapy procedure codes that are listed with a Multiple Services Indicator value of “5” on the CMS physician fee schedule.
Professional claims received on a HCFA 1500 claim form for dates of service on or after February 1, 2026, will be adjudicated per the CMS change request 8206 transmittal 1194. Claims received for dates of service before February 1, 2026, will not be affected.
Who is affected by this change?
- This change will apply to:
- Providers submitting claims with physical, speech, and occupational therapy services on or after February 1, 2026.
- CareOregon and CareOregon Advantage
- This change will not apply to:
- Claims received for dates of service before February 1, 2026.
- At this time, this will not apply to facility claims submitted on a UB04. Changes to UB04 claims pricing will take effect at a later date.
For more information please visit: https://www.cms.gov/regulations-and-guidance/guidance/transmittals/downloads/r1194otn.pdf
