Incentive payments for primary care services
(1) In general
loading…
loading…
loading…
In the case of primary care services furnished on or after January 1, 2011 , and before January 1, 2016 , by a primary care practitioner, in addition to the amount of payment that would otherwise be made for such services under this part, there also shall be paid (on a monthly or quarterly basis) an amount equal to 10 percent of the payment amount for the service under this part.
In this subsection:
(A) Primary care practitioner The term “primary care practitioner” means an individual— (i) who— (I) is a physician (as described in section 1395x(r)(1) of this title ) who has a primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine; or (II) is a nurse practitioner, clinical nurse specialist, or physician assistant (as those terms are defined in section 1395x(aa)(5) of this title ); and (ii) for whom primary care services accounted for at least 60 percent of the allowed charges under this part for such physician or practitioner in a prior period as determined appropriate by the Secretary.
(B) Primary care services The term “primary care services” means services identified, as of January 1, 2009 , by the following HCPCS codes (and as subsequently modified by the Secretary): (i) 99201 through 99215. (ii) 99304 through 99340. (iii) 99341 through 99350.
The term “primary care practitioner” means an individual—
(i) who— (I) is a physician (as described in section 1395x(r)(1) of this title ) who has a primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine; or (II) is a nurse practitioner, clinical nurse specialist, or physician assistant (as those terms are defined in section 1395x(aa)(5) of this title ); and
(ii) for whom primary care services accounted for at least 60 percent of the allowed charges under this part for such physician or practitioner in a prior period as determined appropriate by the Secretary.
who—
(I) is a physician (as described in section 1395x(r)(1) of this title ) who has a primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine; or
(II) is a nurse practitioner, clinical nurse specialist, or physician assistant (as those terms are defined in section 1395x(aa)(5) of this title ); and
is a physician (as described in section 1395x(r)(1) of this title ) who has a primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine; or
is a nurse practitioner, clinical nurse specialist, or physician assistant (as those terms are defined in section 1395x(aa)(5) of this title ); and
for whom primary care services accounted for at least 60 percent of the allowed charges under this part for such physician or practitioner in a prior period as determined appropriate by the Secretary.
The term “primary care services” means services identified, as of January 1, 2009 , by the following HCPCS codes (and as subsequently modified by the Secretary):
(i) 99201 through 99215.
(ii) 99304 through 99340.
(iii) 99341 through 99350.
99201 through 99215.
99304 through 99340.
99341 through 99350.
The amount of the additional payment for a service under this subsection and subsection (m) shall be determined without regard to any additional payment for the service under subsection (m) and this subsection, respectively. The amount of the additional payment for a service under this subsection and subsection (z) shall be determined without regard to any additional payment for the service under subsection (z) and this subsection, respectively.
There shall be no administrative or judicial review under section 1395ff of this title , 1395 oo of this title, or otherwise, respecting the identification of primary care practitioners under this subsection.