Friday, May 3, 2013

Primary Care Rate Increase

The Primary Care Rate Increase (PCRI) is effective for dates of service on and after January 1, 2013 through December 31, 2014. States are required by federal law to reimburse qualified providers at the rate that would be paid for the primary care service (if the service were covered) under Medicare.

A physician is eligible if he or she:

1) FIRST self-attests to practicing in the designated primary care specialties of Family Medicine, General Internal Medicine or Pediatric Medicine


2) Is Board Certified in the designated specialties/subspecialties OR having a 60 percent paid claims history or both E&M codes and vaccine administration codes specified in the regulation.

The PCRI is not available for physicians, nurse practitioners or nurse midwives who are reimbursed through an FQHC, RHC, DTC or a facility's encounter, visit, or per diem rate or who are not practicing in one of the designated primary care specialities.

For more information, refer to page 3 of the CMS FAQ document, FFS Set III:


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