Effective January 1, 2011, qualifying primary care physicians and non-physician practitioners submitting claims to Medicare will be eligible to receive an incentive payment for primary care services. Section 5501(a) of the Affordable Care Act added a new paragraph (x) to section 1833 of The Social Security Act, “Incentive Payments for Primary Care Services” (the PCIP program), which states that, in the case of primary care services rendered on or after January 1, 2011 and before January 1, 2016 by a primary care practitioner, there also will be paid on a monthly or quarterly basis an amount equal to 10 percent of the payment amount for such services under Part B. Section 5501(a)(2)(B) of the Act defines primary care services by Current Procedure Terminology (CPT) codes. A list of eligible codes can be found on page 3 of the MLN Matters Number MM7060, available by clicking here. To receive the incentive payment, the primary care services must have accounted for at least 60 percent of the allowed charges under the Physician Fee Schedule for the practitioner during the time period.

In conjunction with the PCIP, the new Health Professional Shortage Area (HPSA) Surgical Incentive Payment Program (HSIP) will be implemented in 2011. Section 5501(b) of the Affordable Care Act revises section 1833(m) of The Social Security Act and provides for additional incentive payments (on a monthly or quarterly basis) for major surgical services furnished by general surgeons in Health Professional Shortage Areas in an amount equal to 10 percent of the payment for physicians’ professional services under Part B. The incentive payments will also apply to surgical procedures furnished in HPSAs by eligible surgeons who have reassigned their billing rights to a Critical Access Hospital paid under the optional method. To access the MLN Matters Number MM7146 for more detail on this program, click here.