Primary Care Physicians

As part of the Affordable Care Act (ACA), the Centers for Medicare & Medicaid Services (CMS) implemented a rate increase for certain Primary Care Physicians (PCP) and their associated subspecialties. This increased rate became effective January 1, 2013, and ran through December 31, 2014. Nevada Medicaid submitted and received approval from CMS to continue the plan past the federal end date of December 31, 2014. Nevada Medicaid extended the PCP rate increase program for two additional quarters, through June 30, 2015.

The rates for the PCP rate increase were established using the Medicare physician fee schedule rates in effect in calendar years 2013 and 2014. The Medicare fee schedules are established annually and the changes Medicare has made for 2014 will impact the rates being used for the PCP rate increase for calendar year 2014.

Codes/Services that qualified for the enhanced rate were:
1. Evaluation and Management (E&M) codes 99201 through 99499.
2. Current Procedural Terminology (CPT) vaccine

Eligible providers that participated in the rate increase received quarterly incentive payments from 2013 through June 30, 2015. Over the course of the PCP rate increase program, providers received over $45.2 million in Fee-For-Service incentive supplemental payments.


In addition, eligible providers received incentive supplemental payments based on the same methodology as Fee-For-Service claims, calculated and distributed by the two Nevada Medicaid Managed Care Organizations.