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Medicare Primary Care Bonus Payment Program

Bonus Payment Program Overview

What services are considered primary care services?

The law defines primary care services for the purpose of this bonus payment program, by referencing the Current Procedural Terminology (CPT) service-type and code range, as:

• Office/outpatient visits, CPT 99201-99215;
• Nursing facility services, CPT 99304-99318;
• Domiciliary, rest home, or custodial care services, CPT 99324-99340; and
• Home services, CPT 99341-99350.

CMS will use the services identified in the law to implement the bonus payment program. While the law provides the agency to update the list of primary care services based on CPT code changes related to these specific types of services, the agency indicates that it the Affordable Care Act does not give it the authority to designate additional services, e.g. hospital visits, immunizations, as primary care services. The law also does not allow CMS to designate other (non primary care) specialties and subspecialties for eligibility for the bonus.

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