Under the Affordable Care Act (ACA), if a patient who receives an advance premium tax credit does not pay his or her health insurance premiums in full, he or she enters a 90-day “grace period.” During the first month of the grace period, the patient continues to have health insurance coverage, and the patient’s health…
The Medicaid fiscal agent completed required coding for vaccine administration codes CPT 90460, CPT 90471, and CPT 90472 for the Affordable Care Act enhanced rate. Physicians must bill the vaccine product code and the vaccine administration code to receive the full reimbursement allowed by the Affordable Care Act Primary Care rate increase. The federal rule…
Primary care service codes according to the ACA increase Primary care services designated in the Healthcare Common Procedure Coding System (HCPCS) are as follows: (1) Evaluation and Management (E&M) codes CPT 99201 through CPT 99499 (currently covered by Medicaid). (2) Current Procedural Terminology (CPT) vaccine administration codes CPT 90460, CPT 90461, CPT 90471, CPT 90472,…
The Affordable Care Act specifies increased payments for three primary care medical specialties: Family Medicine, General Internal Medicine and Pediatrics. The Final Rule interprets this language to include some subspecialties with a relation to the original three, but does not list the subspecialties. Subspecialists that qualify for higher payment are those recognized by the American…
