Implementation of CC.PP.068 Multiple Procedure Payment Reduction Therapeutic Services
Date: 07/01/25
Multiple Procedure Payment Reduction for Medicaid, Marketplace, and Medicare Therapeutic Services
Effective August 1, 2025, Arizona Complete Health is implementing payment policy CC.PP.068 Multiple Procedure Payment Reduction for Therapeutic Services for the Medicaid (Arizona Complete Care Plan), Marketplace (Ambetter from Arizona Complete Health), and Medicare (Wellcare by Allwell (HMO) and Wellcare (PPO)) lines of business.
Physical, Occupational, and Speech Therapy services are timed-based procedure codes and therefore multiple units may be billed for a single procedure. However, certain practice expense services are not repeated when more than one unit or procedure is provided to the same patient on the same day. Policy CC.PP.068 applies to multiple units and procedures.
Policy CC.PP.068 is based on CMS reimbursement methodologies for Multiple Procedure Payment Reduction for Therapeutic Services and applies a multiple procedure payment reduction to therapeutic procedures assigned a multiple procedure indicator of 5 on the CMS National Physician Fee Schedule. When multiple procedures/units are billed, the unit or procedure with the highest valued paid amount will receive full payment (100% of the paid amount allowance) and subsequent procedures/units will be reimbursed at 90% of the paid amount allowance.
The reduction applies to all therapy services furnished on the same day, regardless of whether the services were provided in one therapy discipline or multiple disciplines, such as physical therapy, occupational therapy, or speech-language pathology.
References:
1. Policy CC.PP.068 Multiple Procedure Payment Reduction for Therapeutic Services is available on our website www.azcompletehealth.com > For Providers > Provider Resources > Clinical & Payment Policies > Payment Policies and on our Marketplace website www.ambetterhealth.com > click on AZ in state map > For Providers > Clinical and Payment Policies > Payment Policies
2. CMS Status Indicators
3. CMS National Physician Fee Schedule
https://www.cms.gov/medicare/payment/fee-schedules/physician
If you have questions, please contact your Provider Engagement Specialist. If you need your assigned Provider Engagement Specialist’s contact information, please email us: AzCHProviderEngagement@azcompletehealth.com