newmexico-pcprate | Providers – Amerigroup

New Mexico PCP Medicaid Increase Rate

Increased Medicaid Rates for Primary Care Physicians (PCPs)

Keep checking here and your state’s Medicaid site for updates.

In accordance with the Patient Protection and Affordable Care Act (ACA), PCPs practicing in family, general internal or pediatric medicine and related subspecialists who meet qualifications will receive enhanced reimbursements for Medicaid services rendered January 1, 2013, through December 31, 2014. The Centers for Medicare & Medicaid Services (CMS) allows each state to determine final guidelines for the rate increase process.

To qualify, you must be certified in an acceptable board or meet the 60-percent claims threshold of eligible codes billed statewide the previous year.

Acceptable boards:

  • American Board of Medical Specialties
  • American Board of Physician Specialties
  • American Osteopathic Association
  • A related subspecialty recognized by one of the three boards above

Acceptable codes:

  • Evaluation and Management: 99201–99499
  • Vaccine administration: 90460, 90461, 90471, 90472, 90473, 90474 or their successors