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Expanding Access to Primary Care Services and General Surgery Services

Section 5501 of The Patient Protection and Affordable Care Act (PPACA) (H.R. 3590) includes provisions to expand access to primary care and general surgery services by amending section 1833 of the Social Security Act.

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.(1)

This section of PPACA provides for additional payment for professional services rendered in a health professional shortage area by a physician, nurse practitioner, clinical nurse specialist, or a physician assistant specializing in primary care, which includes the specialties of family medicine, internal medicine, geriatric medicine, and pediatric medicine. Primary care professional services billed to Medicare that qualify for additional payment are designated by HCPSC codes 99201 through 99215 and 99304 through 99350, as they were defined on January 1, 2009 including any subsequent modifications. For a primary care practitioner to qualify for the 10 percent Medicare bonus payment, 60 percent of his/her services must be designated as primary care professional services.

In addition to providing bonus payments for primary care services, PPACA provides bonus payments to general surgeons for major surgical procedures provided in a health professional shortage area to Medicare patients.

In the case of major surgical procedures furnished on or after January 1, 2011, and before January 1, 2016, by a general surgeon in an area that is designated (under section 332(a)(1)(A) of the Public Health Service Act) as a health professional shortage area as identified by the Secretary prior to the beginning of the year involved, 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.(2)

For a physician to qualify for bonus payment under PPACA, the physician's enrollment must have CMS's specialty code designation 02 - General Surgery as his/her primary specialty. For the physician's services to qualify for the bonus payment, the general surgeon must perform a major surgical procedure, identified by a 10-day or 90-day global period under the fee schedule, for a Medicare patient.

For more information regarding expanding access to primary care services and general surgery services contact HORNE Partner Greg Anderson at

greg.anderson@horne-llp.com or 601.620.5101.


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(1)  H.R. 3590.5501(a)(1)(1)

(2)  H.R. 3590.5501(b)(1)(1)