Reimbursement policy update: Multiple Therapy Services

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is updating its Multiple Therapy Services reimbursement policy effective October 1, 2026.

Currently, the Multiple Procedure Payment Reduction (MPPR) applies only to facility-based Always Therapy services. Beginning on the effective date, the same reimbursement methodology will also apply to professional claims for multiple Always Therapy services performed on the same day by the same group practice. This change aligns with industry reimbursement practices for multiple therapy services across professional and facility settings.

For professional claims, when multiple professional Always Therapy services performed on the same day by the same group practice, the MPPR will apply to the practice expense portion of the Relative Value Unit (RVU).

Under this methodology:

• The primary therapy service with the highest practice expense RVU will be reimbursed at 100% of the practice expense amount.
• All secondary therapy service(s) will be reimbursed at 50% of the practice expense amount.

This reduction applies across all therapy modalities, including:

• Physical therapy
• Occupational therapy
• Speech therapy

Therapy modifier requirements

Therapy services performed under a therapy plan of care must be submitted with the appropriate therapy modifier (Modifier GN, GO, and GP) when reported by physicians, nonphysician practitioners, physical therapists, occupational therapists, or speech-language pathologists in private practice. Please refer to the Modifier Guidelines reimbursement policy for additional information.

For additional details, please review the related Commercial policy notification.

This policy applies to Commercial, Inter-Plan Program (IPP) Host, and Federal Employee Program (FEP). This does not apply to IPP Home. This is already applicable to Medicare Advantage.