CurrentFlorida BluePolicy 10-038

Multiple Therapy Procedure Reduction

Defines Florida Blue's reimbursement reductions when multiple physical medicine and rehabilitation therapy procedures are billed for the same patient on the same date of service; applies to all lines of business and providers billing under the same tax ID.

Policy Summary

PayerFlorida Blue

PolicyMultiple Therapy Procedure Reduction

Policy CodePolicy 10-038

Change TypeClarification

Effective DateAug 1, 2014

Next Review DateApr 9, 2026

Key ActionApply a 25% reduction to secondary and subsequent therapy procedures on the same date of service; allow the primary procedure first unit at 100% and subsequent units at 75%.

SourceLink

POLICY UPDATE CHANGES

Statement added to clarify codes similar in scope and application to those with a MULT PROC value of '5' may be included in the multiple therapy procedure reduction calculation for commercial products.

100%primary procedure first unit allowed

75%secondary & subsequent procedures

MULT PROC = '5'CMS MULT PROC field

CMS-1500billing form/type

Multiple Therapy Procedure Reduction

Policy Summary

PayerFlorida Blue

PolicyMultiple Therapy Procedure Reduction

Policy CodePolicy 10-038

Change TypeClarification

Effective DateAug 1, 2014

Next Review DateApr 9, 2026

Key ActionApply a 25% reduction to secondary and subsequent therapy procedures on the same date of service; allow the primary procedure first unit at 100% and subsequent units at 75%.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Multiple therapy procedure reduction criteria

When multiple therapy procedures are performed on the same date of service for the same patient:

Identify therapy procedure codes subject to reduction using the CMS Medicare Physician Fee Schedule MULT PROC = '5' (commercially, codes similar in scope and application may be included).

Determine the primary procedure as the code with the highest total RVU as published by CMS.

ALL of the following

Primary procedure first unit allowed at 100%.
Primary procedure additional units allowed at the percent allowed shown by unit ranking (examples: 2 units = 87.5%; 3 units = 83.3%; see detailed table).
Secondary and all subsequent distinct procedures allowed at 75% (i.e., reduced by 25%).

ALL of the following

Example 1: Procedure A (highest RVU) 1 unit allowed 100% = $22.00; Procedure B allowed at 75% = $15.00; Procedure C allowed at 75% = $7.50.
Example 2: Procedure A 3 units ($66.00) primary allowed at 83.3% = $54.98; Procedure B single unit allowed at 75% = $15.00.

ALL of the following

Other payment policies (e.g., NCCI) may also apply.
For commercial products, codes not listed as MULT PROC = '5' by CMS but similar in scope may be included in the multiple therapy procedure reduction calculation (clarification added 04/09/2026).

Claims form and provider grouping: This policy applies to claims submitted on CMS-1500 or equivalent form and considers services billed under the same Federal Tax ID as from the same provider.

Therapy Codes and Payment Reductions

Therapy codes subject to multiple procedure reductionmixedCovered

MULT PROC = '5' codes per Medicare PFS Relative Value File

Therapy CPT/HCPCS codes identified with a '5' in the MULT PROC field of the Medicare Physician Fee Schedule Relative Value File are subject to the reduction; similar commercial codes may also be included.

Reduction percentage for secondary procedures/units

Secondary and subsequent procedures (distinct procedures)Allowed at 75% of the fee schedule (i.e., reduced by 25% when performed same date of service)

Primary procedure — first unitAllowed at 100% of the fee schedule

Primary procedure — additional unitsEach subsequent unit after the first is allowed at 75% per unit

Examples of primary percent allowed by unit count2 units = 87.5%; 3 units = 83.3%; 4 units = 81.3%; 5 units = 80.0%; 6 units = 79.2%; 7 units = 78.6%; 8 units = 78.1%

Provider Authorization and Payment Notices

Note

Authorization/Payment Disclaimer

THIS PAYMENT POLICY IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER CERTIFICATE IN EFFECT AT THE TIME SERVICES WERE RENDERED. THIS PAYMENT POLICY APPLIES TO ALL LINES OF BUSINESS AND PROVIDERS OF SERVICE. IT DOES NOT ADDRESS ALL POTENTIAL ISSUES RELATED TO PAYMENT FOR SERVICES PROVIDED TO FLORIDA BLUE MEMBERS AS LEGISLATIVE MANDATES, PROVIDER CONTRACT DOCUMENTS OR THE MEMBER'S BENEFIT COVERAGE MAY SUPERSEDE THIS POLICY.

Key Terms

Same provider

Definition of 'Same provider'Includes all physicians and other health care professionals reporting under the same Federal Tax Identification (tax ID) number

Applies to billing form/typePolicy applies to therapy services billed on CMS-1500 or equivalent claim form

Context for reductionsReduction applies when multiple procedures are performed on the same date of service for the same patient by providers under the same tax ID

Primary procedure (the procedure with the highest total RVU as published by CMS)

Primary procedure — definitionThe procedure with the highest total RVU as published by CMS

Primary procedure selection sourceTotal RVUs published in the CMS Medicare Physician Fee Schedule Relative Value File

Role in reduction calculationPrimary procedure is paid at 100% (first unit) and determines which other procedures are reduced to 75%