Health Professional Shortage Areas

Health Professional Shortage Areas (HPSAs) are geographic areas, that lack sufficient health care providers to meet the health care needs of the area or population.

The Centers for Medicare & Medicaid Services (CMS) provides a 10 percent bonus payment when you furnish Medicare-covered services to beneficiaries in a geographic HPSA.

The HPSA list is updated annually and is effective for services furnished on and after January 1 of each calendar year.

The bonus is paid quarterly and is based on the amount paid for professional services (the adjustment). Since all providers are required to receive electronic funds transfer (EFT) bonus payments are automatically deposited into your account.

HPSAs are mostly designated by ZIP code. But there are areas that are eligible that may not be in a designated ZIP code because:

  1. It does not fall entirely within a designated full county HPSA bonus area
  2. It is not considered to fall within the county based on a determination of dominance made by the U.S. Postal Service
  3. It is partially within a non-full county HPSA or
  4. Services are provided in a ZIP code area not included in the automated file of HPSA areas based on the date of the data used to create the file

For ZIP codes that are not on the automated payment list, visit HRSA Medicare Physician Bonus Payment Eligibility Analyzer for assistance in determining whether an area is in a geographic-based primary care HPSA.

If you furnish services to Medicare beneficiaries in a geographic HPSA that is not on the list of ZIP codes eligible for automatic payment, you must use the AQ modifier, “Physician providing a service in an unlisted Health Professional Shortage Area (HPSA),” on the claim to receive the bonus payment.

Services submitted with the AQ modifier are subject to validation by Medicare. You must ensure that you use the modifier only for services provided to a Medicare beneficiary in an area designated as a geographic primary care HPSA as of December 31 of the prior year.

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