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Medicare Primary Care Bonus Payment Program

Bonus Payment Program Overview

Who is a considered a primary care physician eligible to receive the bonus?

The law defines primary care physicians as those practicing in the following specialties: general internal medicine; family practice; geriatrics; and pediatrics. CMS will determine a physician’s specialty by using the specialty each physician indicated when enrolling to participate in the Medicare program, with the following specialty designations will be eligible for the bonus payment:

• Family practice, specialty designation code “08”;
• Internal medicine, specialty designation code “11”;
• Pediatrics, specialty designation code “37”; and
• Geriatrics, specialty designation code “38”.

Physicians who practice a specialty not identified in the reform law—whether an internal medicine subspecialty or other specialty—are not eligible for the bonus payment. While some internal medicine subspecialists may be in short supply, Congress crafted the provision with the intent of creating incentives for physicians to enter and remain in an office-based, primary care specialty and to ensure access to primary care services provided by such physicians. This program is one part of a broader effort to reverse the declining interest in primary care practice. ACP remains interested in the workforce needs related to subspecialties. ACP is championing other reimbursement changes that would benefit subspecialty internists and hospitalists, including payments for services provided by such physicians as part of a “medical home neighborhood” and advocating for increased relative value units for evaluation and management services provided by all internists. Also, ACP believes that a national workforce commission that is established through ACA will draw appropriate attention to needs across the specialty spectrum.

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