https://www.nejm.org/doi/full/10.1056/NEJMp2413193?query=TOC
Changing Medicare Payment to Strengthen Primary Care
Despite the importance of primary care, visits to primary care practitioners have been decreasing,2 fewer Americans than in past years report having a usual source of primary care,3 and primary care workforce shortages are projected to increase.4
Improved compensation for primary care practitioners could increase the number of medical students applying to enter primary care specialties and enhance access to care.5
The Centers for Medicare and Medicaid Services (CMS), where we work, has recently taken steps to reform primary care payment policies affecting the Medicare Physician Fee Schedule (PFS) in ways that better recognize the importance of primary care and the time and effort required for care teams to develop long-lasting, trusting relationships with patients.
In 2024, CMS implemented new coding and payment policies affecting the PFS that more accurately reflect the work involved in building long-term relationships. Primary care practitioners can use the new billing codes for office visits, with certain exceptions. In the 2025 PFS, CMS allowed these payments to be applied to additional patient encounters, such as visits involving vaccination and other preventive services. Recognizing the resources needed to provide longitudinal care is a step toward correcting long-standing distortions in payment, which have led to fewer clinicians entering primary care than the United States requires and gaps in access for patients.
The NASEM report made several recommendations for supporting primary care in the United States, including “pay[ing] for primary care teams to care for people, not doctors to deliver services.”1
Over the past decade, CMS has updated the PFS to permit payment for components of team-based primary care, implementing billing codes and payments for care management and digital communication services. But uptake has been low. We have received feedback that requirements to document how every minute of time providing these services is spent have hampered adoption. CMS therefore created new coding and payment policies for advanced primary care management (APCM) services in the 2025 PFS final rule. The new codes will reduce administrative burdens by not requiring time-based documentation (every minute of a team member’s time won’t need to be catalogued). Instead, primary care teams will be able to use the codes if they provide certain services that are known to be fundamental to high-quality primary care (see box). Not every service will need to be provided every month for every patient; services should be provided when the patient’s clinical circumstances warrant them.