Medicare’s new payment codes could reshape primary care, but big questions remain

Medical Economics September 16, 2025
Austin Littrell, Keith A. Reynolds

Key Takeaways

• New Medicare payment codes for primary care and behavioral health could significantly increase practice revenue, reducing administrative burdens.
• Barriers like documentation, capacity constraints, and patient cost-sharing may limit the adoption of new codes.
• CMS’s proposed funding redistribution may face resistance from specialties, potentially affecting the broader healthcare landscape.
• While these changes are a step forward, success is uncertain due to factors like corporate consolidation and uneven uptake.

A JAMA viewpoint argues new reimbursement policies may deliver long-sought revenue to primary care, though uptake, staffing and fee cuts elsewhere cloud the outlook.

For decades now, federal and state officials have experimented with ways to bolster primary care financing, from case management fees to alternative payment models. Yet...

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