Primary Care Bonuses Kick In

Medicare has begun paying primary care physicians a 10-percent bonus for providing primary care services. The Primary Care Incentive Program [PDF] is part of the Affordable Care Act, otherwise known as health system reform,  that Congress passed last year.

 Paid quarterly, the payments equal 10 percent of the payment amount for primary care services under Medicare Part B. Primary care physicians (physicians enrolled in Medicare with a primary specialty of: family medicine, internal medicine, geriatrics, or pediatrics) and nonphysician practitioners (practitioners enrolled in Medicare as physician assistants, nurse practitioners, or clinical nurse specialists) who furnish primary care services involving the following service codes from Jan. 1, 2011, through Dec. 31, 2015, are eligible for the payments:

  • 99201–99215, 
  • 99304–99340, and
  • 99341–99350.

The Centers for Medicare & Medicaid Services (CMS) says physicians should remember these key points: 

  • Primary care services must account for at least 60 percent of the allowed charges under Part B for the provider in a prior period.
  • If a group or practice bills for a primary care service, the primary care professional service must be rendered by one of the eligible providers and be reflected by the rendering National Provider Identifier (NPI) for the claim detail.
  • CMS will extract eligible providers by rendering NPIs and provide contractors with the information at the beginning of each year. These two files will be issued to Medicare contractors:
    • PCIP Eligibility File – Lists qualifying NPIs. Medicare contractors will post this file on their websites by the end of January of each year. The incentive will be calculated on the amount paid for each quarter for the codes billed by the Provider Transaction Access Numbers  associated with each qualifying NPI listed on the file.
    • Physician/Specialty File – Lists physician/nonphysician practitioner information by NPI.

In addition to the bonuses, Medicare began reimbursing physicians for an annual checkup or wellness visit [PDF] for beneficiaries. This also is part of the health system reform bill.

Finally, the Affordable Care Act waives copayments [PDF] for most preventive services. Medicare will pay 100 percent of the cost of these services.


Action, Jan. 4, 2010


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