Tennessee PCP Medicaid Rate Increase | Providers – Amerigroup

Tennessee PCP Medicaid Rate Increase

Increased Medicaid Rates for Primary Care Physicians (PCPs)

In accordance with the Patient Protection and Affordable Care Act (ACA), PCPs practicing in family medicine, general internal or pediatric medicine and related subspecialists who meet specified requirements will be eligible to receive enhanced reimbursements for 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 in 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 following:
    • The American Board of Medical Specialties (ABMS)
    • The American Board of Physician Specialties (ABPS)
    • The American Osteopathic Association (AOA)

Acceptable Codes:

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

If you feel you are eligible for the enhanced rate and did not receive a notification from us, call us at 1-800-454-3730.