Ohio Primary Care Physicians to See Increase in Medicaid Reimbursement

Ohio Administrative Code (OAC) rule 5101:3-1-60.3 is being adopted to comply with the Affordable Care Act, which requires a qualified physician with a specialty designation of family medicine, internal medicine, or pediatric medicine is eligible for increased payment. Sub-specialists within the specialty designations of family medicine, general internal medicine, and pediatric medicine, as recognized by the American Board of Medical Specialties, may also be eligible for increased payment.

The primary care services subject to the increased payment are Current Procedural Terminology (CPT) evaluation and management procedure codes 99201 to 99499, and CPT vaccine administration codes 90460, 90461 and 90470 to 90474.

The reimbursement to be paid to a qualified provider for rendering the specified primary care services contained in this rule will be either 100 percent of the 2013 or 2014 Medicare Physician Fee Schedule allowed amount applicable to site of service, or the amount calculated by replacing the 2013 or 2014 conversion factor with the 2009 conversion factor, whichever results in a higher fee.

This new rule will be effective from Jan. 1, 2013 through Dec. 31, 2014. Click here to view a copy of the proposed rule.

Want to continue the discussion on the OSMA Community? Click here to post your thoughts and connect with your peers on the OSMA’s member-only forum.