Article Detail - JE Part B

Section 1833(m) of the Act provides bonus payments for physicians and psychiatrists serving areas designated as primary medical care HPSAs under section 332(a)(1)(A) of the Public Health Service (PHS) Act. Make sure your billing staff understand how to bill these claims to make sure you get paid properly.

• As of January 1, 2005, no modifier is needed for services in HPSA zip codes.
• If services provided are in zip code that does not fall entirely within a full, or partial HPSA county, the AQ modifier must be added to the claim.
• MACs will continue to accept the AQ modifier for partially designated HPSA claims.
• Use the following link to determine if you are in a HPSA area:
  • CMS Physician Bonuses

Resource

• CMS MM11852 2021 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments)
• CMS Physician Bonuses in Health Provider Shortage Areas (HPSA)