Back to top

Are You Participating in the Primary Care Incentive Program?

Coding Corner

The information provided here applies to Medicare coding. Be sure to check with your Medicare Administrative Contractor (MAC) for additional information and clarification on these and other items. You should also contact your local insurance carriers to determine if private insurers follow Medicare's lead on all coding matters.

Are You Participating in the Primary Care Incentive Program?
Section 5501(a) of the Patient Protection and Affordable Care Act (PPACA, Pub. L. 111-148) created incentive payments for primary care services provided after January 1, 2011 and before January 1, 2016. Eligible providers may be paid an amount equal to 10 percent of the payment amount for such services under Part B. The PPACA defines primary care services using the Current Procedure Terminology (CPT) codes as follow:

  • 99201 through 99215 (office and other outpatient visits)
  • 99304 through 99340 (nursing facility, domiciliary, rest home, or custodial care)
  • 99341 through 99350 (home services).

Additional information on the Primary Care Incentive Program is available at www.cms.gov/MLNMattersArticles/Downloads/SE1109.pdf.