Medicaid Fee Increase HHSC approves raise for physicians

by David Henkes, MD chair, TMA Physician Payment Advisory Committee

Acting on recommendations submitted by the Physician Payment Advisory Committee (PPAC), the Texas Health and Human Services Commission on Jan 18 implemented additional increases for physicians and other practitioners participating in the Medicaid program.

Medicaid fee increases were a top priority for the Texas Medical Association and DCMS during the 2001 session of the Texas Legislature.

The first increase is for CPT code 99213, which will rise from $27.28 to $29.52, an 8.2 percent increase. The second increase is targeted to the “high-volume” Medicaid practitioner, defined as a primary care physician who averages at least 300 Medicaid patient encounters per month, or a specialty care physician who provides the top 50 percent of services within his specialty. Fee increases will be implemented statewide in both the traditional Medicaid and Medicaid managed care service areas.

Physicians classified as high-volume practitioners will be notified by the state within the next several weeks. On average, high-volume specialists will receive a 6.1-percent payment increase, while high-volume primary care physicians will receive a 1.9-percent increase. The PPAC recommended giving high-volume specialty physicians a larger percentage increase because primary care physicians principally will benefit from the increase in CPT code 99213, as well as increases enacted in 2001.

The newest recommendations build on a fee increase enacted Sept 1 that raised the fees for Texas Health Steps medical screening exams from $49 to $70. All the fee updates were ordered by the last session of the Legislature, which directed the state Medicaid program to increase payments for Medicaid professional services by $50 million over the 2002–2003 biennium. The Legislature directed the Medicaid program to use the new monies to improve primary care services and to reward the vital high-volume practitioners along the Texas-Mexico border, in inner-city communities, and in rural counties.