Corporate

Primary Care Incentive Program (PCIP) Tool

For primary care services furnished on or after January 1, 2011 and before January 1, 2016, a 10 percent incentive payment will be provided to primary care practitioners. CMS has provided CGS with a list of the National Provider Identifiers (NPIs) of the primary care practitioners eligible to receive the incentive payments. Use this tool to find out if you are eligible to participate in the Primary Care Incentive Program.

 

**In order for the physician or NPP to qualify for the PCIP payment, the following criteria must be met:

  • The incentive payment is determined by the primary specialty;
  • Primary care services must account for at least 60 percent of the practitioner's payments under Part B; and
  • Primary care percentage is calculated based on claims data from 2 years prior to the PCIP payment year

For newly enrolled Medicare practitioners who do not have claims data from two years prior to the PCIP payment year upon which an eligibility determination can be made, Medicare will make PCIP eligibility determinations based upon the claims data from the year before the PCIP payment year.

Refer to MLN Matter Article SE1109, for more information.

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1109.pdfExternal PDF

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