> For the complete documentation index, see [llms.txt](https://docs.pravatherapy.com/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://docs.pravatherapy.com/payouts.md). # Payouts We pay out on a weekly basis any payments that have been received from clients or insurance. Every Tuesday you will get an email with your payout summary that lists the current week’s payout as well as pending payments. Payments are submitted on Wednesday and will show up in your account on either Thursday or Friday of the same week. It typically takes about 3 weeks for a payer (some payers take 1-2 weeks others can take over 4 weeks) to process a claim, after which point the session will be scheduled for the next payout cycle. The platform that we use for payouts is [Gusto](http://gusto.com). You should have received an invite to create your account as part of your first payout cycle. If you haven’t, please reach out to to get an invite sent out to you. ## Changing your payment information You can do this directly in Gusto. Please see [Gusto Help Center - Edit bank and personal information (for US employees and contractors)](https://support.gusto.com/article/137880230100000/Edit-bank-and-personal-information-for-US-employees-and-contractors) ## Accessing my 1099 You can view your 1099 through Gusto: [Gusto Help Center - View my 1099-NEC (as a contractor)](https://support.gusto.com/article/106622213100000/View-my-1099-NEC-as-a-contractor) ## MPPR For Medicare, Managed Medicare and some commercial plans (e.g. Aetna) there is an important nuance in how reimbursement works in the case of multiple units being billed on the same date of service. This is referred to as the [Multiple Procedure Payment Reduction](https://www.ngsmedicare.com/en/web/ngs/physical-therapy/occupational-therapy/speech-therapy?selectedArticleId=865043\&lob=96664\&state=97057\&rgion=93623) policy and it applies to all PT/ST/OT codes. The first unit of the code with the highest reimbursement rate is paid out at the full 100% rate. Every other unit is paid out at a *reduced rate.* The reduction varies by payer: * For Medicare & Managed Medicare: the *practice expense* component of the fee is paid out at 50%. The practice expense is typically around 50% of the overall fee, so this results in an \~25% decrease in the overall reimbursement rate for that unit. * For Aetna Commercial (all states): they apply a 15% discount to any additional units. To provide some examples, let’s assume the following fee schedule for Medicare: * 97530: $28.00/unit * 97110: $24.00/unit * 97161: $80.00/unit Example 1: Treatment Session (Medicare) | | **Without MPPR** | **With MPPR** | | ------------- | ----------------------------------------------------------- | --------------------------------------------------------------------------------------- | | **Breakdown** |

97530 - 3 Units - $28.00
97110 - 2 Units - $24.00

|

97530 - 1 Units - $28.00
97530 - 2 Units - $21.00
97110 - 2 Units - $18.00

| | **Total** | $132 | $106 | Example 2: Eval + Treatment Session (Medicare) | | **Without MPPR** | **With MPPR** | | ------------- | ---------------------------------------------------------- | ----------------------------------------------------------- | | **Breakdown** |

97161 - 1 Unit - $80.00
97110 - 3 Units - $24.00

|

97161 - 1 Units - $80.00
97110 - 3 Units - $18.00

| | **Total** | $152 | $134 | Example 3: Treatment Session (Aetna) | | **Without MPPR** | **With MPPR** | | ------------- | ----------------------------------------------------------- | --------------------------------------------------------------------------------------- | | **Breakdown** |

97530 - 3 Units - $28.00
97110 - 2 Units - $24.00

|

97530 - 1 Units - $28.00
97530 - 2 Units - $23.80
97110 - 2 Units - $20.40

| | **Total** | $132 | $116.4 | ## Medicaid Secondary Reduction Federal law prohibits providers from billing Medicaid enrollees for any out of pocket costs their primary insurance doesn’t cover, ensuring that beneficiaries have no legal obligation to pay for services outside of Medicaid costs. For example, if a primary payer covers 80% of the costs - the remaining 20% will be sent to Medicaid. However, Medicaid’s allowed amount is almost always significantly lower than the primary’s which results in Medicaid not covering any of the remaining 20%. In Illinois for example, Medicaid only reimburses about $7/unit. So for a 4 unit session that is $100, if the primary insurance covers 80% ($80) this is already higher than the $28 Medicaid determines as the allowed amount, so Medicaid won’t pay any of the remaining $20. Given the legal protections mentioned above, the end result here is that the provider only gets reimbursed for 80% of the services with no way to get reimbursed for the final 20%. We account for this in payouts by reducing the overall payout for 20% for any patients with Medicaid secondary insurance. Example: | | **Without Reduction** | **With Reduction** | | ------------- | --------------------------------------------------------- | ------------------------------------------------------------------------------------------------ | | **Breakdown** |

97530 - 3 Units: $30.00
97110 - 2 Units: $20.00

|

97530 - 3 Units: $30.00
97110 - 2 Units: $20.00
Medicaid Adjustment (-20%): -$26.00

| | **Total** | $130 | $104 | --- # Agent Instructions This documentation is published with GitBook. GitBook is the documentation platform designed so that both humans and AI agents can read, navigate, and reason over technical content effectively. Learn more at gitbook.com. ## Querying This Documentation If you need additional information that is not directly available in this page, you can query the documentation by asking a question. Perform an HTTP GET request on the following URL with the `ask` and `goal` query parameters: ``` GET https://docs.pravatherapy.com/payouts.md?ask=&goal= ``` `ask` is the immediate question: it should be specific, self-contained, and written in natural language. `goal` is what the user is ultimately trying to achieve, the reason they need the answer. Sharing it helps GitBook give you a better, more relevant answer. A goal is most helpful when it describes the outcome the user wants rather than restating the question. For example, with `ask=how do I create an API token`, a goal like `automate deployments from our CI pipeline` lets GitBook tailor the answer to that use case. The response will contain a direct answer to the question and relevant excerpts and sources from the documentation. Use this mechanism when the answer is not explicitly present in the current page, you need clarification or additional context, or you want to retrieve related documentation sections.