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January 25, 2018

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Medical Coding News Archives

Primary Care Incentive Payment Could Significantly Boost Income

July 12, 2012:

Deborah C. Hall, Clinical/Technical Editor

The Centers for Medicare and Medicaid Services (CMS) has announced that for 2011 more than $560 million dollars was paid for the Primary Care Incentive Payment Program (PCIP). According to recently released CMS statistics, 50.1 percent of internal medicine physicians received PCIP bonuses totaling $279,618,773. The specialty receiving the next highest payout was family practice—38.2 percent of providers received PCIP incentives for a total of $212,987,540.

Section 5501(a) of the Affordable Care Act (ACA) authorized Medicare to make quarterly incentive payments to certain providers who provide primary care services between January 1, 2011 and January 1, 2016. Eligible PCPs who provide CMS designated primary care services could receive a 10 percent incentive payment for those services.

Eligible providers include those with a Medicare specialty designation of family, geriatric, pediatric, or internal medicine as well as specific nonphysician practitioners (nurse practitioner, clinical nurse specialist, or physician assistant). These providers qualify for the incentive when at least 60 percent of their allowed Medicare charges were for primary care services.

Eligible evaluation and management primary care services include the following:

  • 99201–99215 New and established office or other outpatient
  • 99304–99340 Initial, subsequent, discharge and other nursing, domiciliary, rest home, or custodial care E/M services
  • 99341–99350 New and established home visits

Click here for more detailed information on the PCIP, eligibility requirements and payment policies.


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