Payment Matters: Primary Care Providers and General Surgeons Benefit from Increased Medicare Reimbursement


Effective January 1, 2011, and continuing to December 31, 2015, qualifying primary care providers and general surgeons in health professional shortage areas will benefit from a 10% increase in their reimbursement for certain services from Medicare Part B. This increased reimbursement from the Patient Protection and Affordable Care Act (PPACA) creates incentives to general practitioners to provide much needed primary care and general surgery services. PPACA, Pub. L. No. 111- 148, § 5501 [PDF]; 2011 Physician Fee Schedule, Final Rule, Fed. Reg. 73170, 73431-43 (Nov. 29, 2010).

A. Qualifying Primary Care Providers and the Primary Care Incentive Payment

In order for primary care providers to receive the 10% increased Medicare reimbursement, those providers must have both a qualifying enrollment code and have billed a sufficient quantity of qualifying HCPCS codes in 2009 and 2010. The 10% reimbursement increase applies only to physicians who enrolled with Medicare with the specialty code for family internal, geriatric, or pediatric medicine. Nurse practitioners, clinical nurse specialists, and physician assistants enrolled in Medicare are also eligible for the 10% increased reimbursement.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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