(Medicare Claims Processing Manual)

For information on PCIP payments to CAHs paid under the optional method, see the Medicare Claims Processing Manual, Pub. 100- 04, Chapter 4, 250.12.   On an annual basis A/B MACs (B) shall receive a Primary Care Incentive Payment Program Eligibility File and PCIP Payment for New Providers Enrolled in Medicare File that they shall post to their websites.  The files will list the NPIs of all practitioners who are eligible to receive PCIP payments for the PCIP payment year.   B. Method of Payment    Calculate and pay qualifying primary care practitioners an additional 10 percent incentive payment.    Calculate the payment based on the amount actually paid for the services, not the Medicare approved amount.    Combine the PCIP incentive payments, when appropriate, with other incentive payments, including the HPSA physician bonus payment, and the HPSA Surgical Incentive Payment Program (HSIP) payment;    Provide a special remittance form that is forwarded with the incentive payment so that physicians and practitioners can identify which type of incentive payment (HPSA physician and/or PCIP) was paid for which services.    Practitioners should contact their A/B MAC (B) with any questions regarding PCIP payments.   C. Changes for Contractor Systems   The Medicare Carrier System, (MCS), Common Working File (CWF) and the National Claims History (NCH) shall be modified to accept a new PCIP indicator on the claim line.  Once the type of incentive payment has been identified by the shared systems, the shared system shall modify their systems to set the indicator on the claim line as follows:   1 = HPSA;  2 = PSA;  3 = HPSA and PSA;  4 = HSIP;  5 = HPSA and HSIP;  6 = PCIP;  7 = HPSA and PCIP; and  Space = Not Applicable.   The MCS shall send the HIGLAS 810 invoice for incentive payment invoices, including the new PCIP payment.  The A/B MAC (B) shall also combine the providers HPSA physician bonus, physician scarcity (PSA) bonus (if it should become available at a later date), HSIP payment and/or PCIP payment invoice per provider.  The A/B MAC (B) shall receive the HIGLAS 835 payment file from HIGLAS showing a single incentive payment per provider.    240 - Marriage and Family Therapist (MFT) Services (Rev.12448; Issued:01- 11-24; Effective: 01 -01-24; Implementation: 02 -12-24)  See Medicare Benefit Policy Manual, Chapter 15, for coverage requirements.  Assignment of benefits is required.  Payment is at 75 percent of the amount that a clinical psychologist is paid under the physician fee schedule.    MFTs are identified on the provider file by specialty code E1.   250 - Mental Health Counselor (MHC) Services  (Rev.12448; Issued:01- 11-24; Effective: 01 -01-24; Implementation: 02 -12-24)  See Medicare Benefit Policy Manual, Chapter 15, for coverage requirements.  Assignment of benefits is required.  Payment is at 75 percent of the amount that a clinical psychologist is paid under the physician fee schedule.  MFTs are identified on the provider file by specialty code E2.             Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R12461CP  01/18/2024  Guidance for the Implementation of the Office and Outpatient (O/O) Evaluation and Management (E/M) Visit Complexity Add-on Code G2211  02/19/2024  13473  R12448CP  01/11/2024  Updates to Medicare Benefit Policy Manual and Medicare Claims Processing Manual for Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) 02/12/2024  13469  R12423CP  12/20/2023  Enforcing Billing Requirements for Intensive Outpatient Program (IOP) Services with New Condition Code 92 01/02/2024  13222  R12370CP  11/21/2023  Implement Edits to Prevent Payment of Complexity Add-On Code G2211 When Associated Office/Outpatient Evaluation and Management Visit (Codes 99202-99205, 99211-99215) is Reported With Modifier 25 NO LONGER SENSITIVE  01/02/2024  13272   07/28/2023  Implement Edits to Prevent Payment of Complexity Add-On Code G2211 When Associated Office/Outpatient Evaluation and Management Visit (Codes 99202-99205, 99211-99215) is Reported with Modifier 25 SENSITIVE CONTROVERSIAL  Rescinded and replaced by Transmittal  12370 01/02/2024  13272  R11842CP  02/09/2023  Internet-Only Manual (IOM) Updates to Pub. 100-04, Chapter 12 for the New Hospital Inpatient or Observation Care Code Family, Nursing Facility Visits Code Family, Billing the Substantive Portion of a Split (or Shared) Visit, Changes for Prolonged Services, and Updates to the IOM with Policies Finalized for Office/Outpatient E/M Visits in the 05/09/2023  13064  Rev #  Issue Date  Subject  Impl Date  CR#  CY2020 and CY2021 Final Rules  R11828CP  02/02/2023  Correction of Split (or Shared) Critical Care Billing Requirement in Section 30.6.12.5. of Chapter 12 of the Medicare Claims Processing Manual  03/03/2023  13065  R11732CP  12/08/2022  Billing Instructions for Home or Residence Services  01/03/2023  13004  R11288CP  03/04/2022  Internet-Only Manual Updates (IOM) for Critical Care, Split/Shared Evaluation and Management Services, Teaching Physicians, and Physician Assistants  02/15/2022  12543  R11287CP  03/02/2022  Internet- Only Manual Updates for Critical Care Evaluation and Management Services  02/22/2022  12550  R11195CP  01/20/2022  Internet- Only Manual Updates for Critical Care Evaluation and Management Services  - Rescinded and replaced by Transmittal 11287  02/22/2022  12550  R11181CP  01/14/2022  Internet-Only Manual Updates (IOM) for Critical Care, Split/Shared Evaluation and Management Services, Teaching Physicians, and Physician Assistants -Rescinded and replaced by Transmittal 11288 02/15/2022  12543  R10742CP  05/03/2021  Revisions of Sections 30.6.1(B), 30.6.12, and 30.6.13(H) of Chapter 12 of the Medicare Claims Policy Manual  05/09/2021  12275  R10716CP  04/06/2021  Common Working File (CWF) Edits for Medicare Telehealth Services and Manual Update  07/06/2021  12068  R10618CP  03/16/2021  Common Working File (CWF) Edits for Medicare Telehealth Services and Manual Update- Rescinded and replaced by Transmittal 10716 07/06/2021  12068  Rev #  Issue Date  Subject  Impl Date  CR#  R10639CP  03/12/2021  Update to the Manual for Telephone Services, Physician Assistant (PA) Supervision, and Medical Record Documentation for Part B Services  04/12/2021  11862  R10356CP  09/18/2020  Update to the Medicare Claims Processing Manual  10/19/2020  11958  R4431CP.  11/01/2019  Health Professional Shortage Area (HPSA) Bonus Payments for All Mental Health Specialties  02/04/2019  11327 R4339CP  07/25/2019  Documentation of Medical Necessity of the Home Visit; and Physician Management Associated with Superficial Radiation Treatment  08/27/2019  11273 R4309CP  05/24/2019  Documentation of Medical Necessity of the Home Visit; and Physician Management Associated with Superficial Radiation Treatment - Rescinded and replaced by Transmittal 4339 08/27/2019  11273 R4283CP  04/26/2019  Documentation of Evaluation and Management Services of Teaching Physicians 07/29/2019  11171 R4173CP  11/30/2018  Revision of Definition of the Physician Supervision of Diagnostic Procedures, Clarification of DSMT Telehealth Services, and Establishing a Modifier for Expanding the Use of Telehealth for Individuals with Stroke  01/02/2019  11043 R4068CP  05/31/2018  E/M Service Documentation Provided by Students (Manual Update) 03/05/2018  10412 R3971CP  02/02/2018  E/M Service Documentation Provided by Students (Manual Update)  Rescinded and replaced by Transmittal 4068 03/05/2018  10412 R3883CP  10/13/2017  Payment for Services Furnished by 01/16/2018  10275 Rev #  Issue Date  Subject  Impl Date  CR#  Qualified Nonphysician Anesthetists