Improved Medicaid payments to primary care physicians


With the obvious intent to improve access to primary care for Medicaid recipients, the Health Care and Education Affordability Reconciliation Act of 2010 will increase Medicaid payment rates to at least the level of the Medicare rates for Evaluation & Management (E&M) codes in 2013 and 2014.  The new rates will be available to all physicians with a primary specialty designation of family practice, general internal medicine, or pediatrics.

For these physicians, Medicare rates will also apply to services related to immunization administration for vaccines and toxoids for which CPT codes 90465, 90466, 90467, 90468, 90471, 90472, 90473, or 90474 (as subsequently modified) apply.

The increased payment requirement would also apply to Medicaid managed care plans, “regardless of  the manner in which such payments are made, including in the form of capitation or partial capitation.”

%d bloggers like this: