Through the efforts of the Georgia Academy of Family Physicians and our colleagues with the Georgia Chapter-American Academy of Pediatrics, Georgia OB Gyn Society, Georgia Chapter-American College of Physicians and the Georgia Osteopathic Medical Association-family physicians will see an increase of up to 135 percent in some codes. Fee for Service Medicaid will increase pending an approval from CMS causing a 6-8 month delay.
However, these code increases will allow many family physicians to continue to care for their Medicaid patients. Please note the codes and the change in payment below.
Physician Rate Increase for Primary Care
Effective July 1, 2016 for CMO’s
Pending for Fee for Service (CMS Approval) – 6- 8 month delay
| Code Description of Service | Current Medicaid 100% | CY14 Medicare | Change |
| 90460 Vaccine admin, 1-18 years with counseling | $10.00 | $21.93 | 119% |
| 90471 Vaccine admin | $10.00 | $23.54 | 135% |
| 90472 Vaccine admin, each add component | $10.00 | $11.98 | 20% |
| 99202 Office/outpt visit, new pt | $54.57 | $71.33 | 31% |
| 99203 Sick visit, New Patient | $76.53 | $103.80 | 36% |
| 99204 Sick Visit, New Patient | $110.51 | $160.29 | 45% |
| 99205 Sick Visit, New Patient | $137.12 | $200.13 | 46% |
| 99212 Office/Outpt visit established patient | $29..67 | $41.63 | 40% |
| 99213 Office Visit, established patient | $63.14 | $70.15 | 11% |
| 99214 Office Visit, established patient | $62.71 | $103.72 | 65% |
| 99215 Office/outpt, established patient | $93.46 | $139.20 | 49% |
| 99217 Observation care discharge | $57.41 | $70.82 | 23% |
| 99218 Observation care | $60.29 | $97.53 | 62% |
| 99211 Initial hospital care | $60.29 | $99.85 | 66% |
| 99222 Initial hospital care | $99.20 | $135.59 | 37% |
| 99231 Subsequent hospital care | $30.80 | $38.59 | 25% |
| 99232 Subsequent hospital care | $48.02 | $70.85 | 23% |
| 99233 Subsequent hospital care | $67.47 | $102.06 | 51% |
| 99238 Hospital Discharge day | $57.11 | $70.82 | 24% |
| 99239 Hospital Discharge day | $79.92 | $104.69 | 31% |
| 99244 Office Consultation | $139.12 | $180.26 | 30% |
| 99381 Initial Preventive Visit new pt, infant | $67.38 | $106.68 | 58% |
| 99460 Initial newborn, E/M per day, hospital | $64.89 | $93.25 | 44% |
| 99462 Subsequent newborn, E/M per day | $34.66 | $41.48 | 20% |
| 99468 Neonatal critical care, Initial | $683.12 | $919.12 | 35% |
| 99469 Neonatal critical care, Subsequent | $341.09 | $390.13 | 14% |
| 99477 Initial neonate, E/M per day hospital | $247.49 | $342.26 | 38% |
| 99391 Preventive Visit Est. pt infant | $86.47 | $96.08 | 11% |
| 99392 Preventive Visit Est pt. Age 1-4 | $92.46 | $102.74 | 11% |
| 99393 Preventive Visit, Est. pt Age 5-11 | $92.17 | $102.41 | 11% |
| 99394 Preventive Visit, Est. pt Age12-17 | $101.03 | $112.25 | 11% |
| 99395 Preventive Visit, Est. pt. | $103.24 | $114.71 | 11% |