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.

Please see full alert below for more information.

LOADING PDF: If there are any problems, click here to download the file.

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.

© Ober|Kaler | Attorney Advertising

Written by:


Ober|Kaler on:

JD Supra Readers' Choice 2016 Awards
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:

Sign up to create your digest using LinkedIn*

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.

Already signed up? Log in here

*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.