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AHCCCS continues to monitor whether Congress will authorize continued federal funding for
enhanced reimbursement for eligible primary care services for dates of service on and after
January 1, 2015. To date, no such funding has been allocated. Should Congress not approve the
enhanced payments for 2015 in the next few months, AHCCCS will discontinue the enhanced
reimbursement for eligible primary care services for dates of service beginning January 1, 2015.
Congress has occasionally authorized expenditures that take effect retroactively.
In the event that Congress approves the enhanced federal funding for eligible primary care
services after January 1, 2015, AHCCCS will notify providers and MCO’s of the process for
obtaining such reimbursement.
Continue to check this page for updates.
Pursuant to federal law the AHCCCS Administration will be increasing reimbursement for primary care services furnished
by or under the personal supervision of certain physicians for dates of service January 1, 2013 through December 31,
2014. The increased payments are required by Sections 1902(a) (13), 1902 (jj), 1905 (dd) and 1932(f) of the Social
Security Act and federal regulations in 42 CFR Parts 438, 441, and 447. These regulations are described in the final
rule published in 77 Federal Register 66670 on November 6, 2012.
The increased payments are mandated by Section 1202 of the Affordable Care Act (ACA) which requires Medicaid programs
to pay fees to designated physicians that are no less than the Medicare fee schedule in effect for 2013 and 2014 or the
fee schedule rate that would result from applying the 2009 Medicare physician fee schedule conversion factor to the 2013
or 2014 Medicare payment rates, whichever is greater. The increased payment requirements apply to primary care and
vaccine administration services described by the following codes:
Current Procedural Terminology (CPT) Evaluation and Management (E&M) Codes 99201 through 99499, and
Increased payment rates may apply to nurse practitioners (NP) and physician assistants (PA)
when they practice under the supervision of a qualified physician.
Physicians who meet the criteria below must complete the online Attestation
form to receive enhanced reimbursement.
Increases in reimbursement are limited to physicians who
attest that they are either:
1) Board certified with a specialty designation of family medicine, general internal
medicine, or pediatric medicine, or a subspecialty of family medicine, general internal medicine, or pediatric
medicine recognized by the American Board of Medical Specialties, the American Osteopathic Association, or the
American Board of Physician Specialties ( refer to the application form) or
2) A primary care physician or
subspecialist who works in one or more of the above specialty
designations but who does not have a certification specified
in 1 but has billed at least 60% of Medicaid services provided, using the
E&M and vaccine administration codes list above, during calendar year 2012. For newly eligible physicians, the
60% billing requirement will apply to Medicaid claims for the prior month. For eligible physicians who register
as AHCCCS providers in CY13 or CY14, the 60% billing requirement will apply to Medicaid claims for the prior
month using the E&M and vaccine administration codes listed above.
We have recently received further guidance from CMS (Center for Medicare & Medicaid Services) regarding
the provider qualifications for primary care service enhanced payments. In order to qualify for the
enhanced reimbursement, providers must attest as being board certified (as outlined above) by providing the
begin date and the end date (or renewal date) of the board certification.
In addition, CMS recently received information from the American Board of Medical Specialties (ABMS)
attesting that the American Board of Allergy and Immunology (ABAI) is an ABMS-recognized sub-discipline of
the American Board of Pediatrics and the American Board of Internal Medicine, making their board
certification eligible for enhanced payments. As with all other board certifications, the certification
from ABAI must be current to qualify for enhanced payments.
If you fall into this category, please complete Certification and Attestation for PC Rate Increase Form A [PDF] and
Care Physician Certification form [PDF] or Form B [PDF] and fax to Provider Registration at 602-256-1474.
After reviewing the instructions below - follow this link to the AHCCCS Online
NOTE: If you are unable to attest online, please email
OIGProvider@azahcccs.gov to request paper forms.
Online Attestation for a Physician (MD) and/or Osteopath (DO):
All corrections/changes, after attestation, will need to be sent to
OIGProvider@azahcccs.gov, and may be required to complete additional forms
For a physician who has attested and wants to include PAs or NPs under his/her supervision the Supplemental Form B must be
completed for each NP and PA. To complete the Supplemental Form B:
Adobe Acrobat Reader is required to view PDF files. This is a free program available
from the Adobe web site. Follow the download directions on the Adobe
web site to get your copy of Adobe Acrobat Reader.