Mental Health Professional Shortage Areas - Part B
In accordance with Section 1833(m) of the Social Security Act, physicians who provide covered professional services in a geographic HPSA are entitled to a 10-percent incentive payment. The Health Resources and Services Administration (HRSA), within the Department of Health & Human Services, is responsible for designating shortage areas.
The address where the service is rendered, not the location of the physician's office or the patient's address, is the determining factor in HPSA incentives.
Only physicians, including psychiatrists, furnishing services in a primary medical care HPSA are eligible to receive bonus payments. In addition, effective for claims with dates of service on or after July 1, 2004, psychiatrists, specialty 26, furnishing services in mental health HPSAs are eligible to receive bonus payments. However, should an area be both a mental health HPSA and a primary care HPSA, only one ten-percent incentive payment will apply to a single service. Non-physician practitioners, such as clinical psychologists and clinical social workers, are not eligible for the bonus payment.
The incentive payment is issued quarterly. It is 10 percent of the amount actually paid by Medicare, not the approved amount, for services performed in a geographic HPSA. It is not necessary for the physician to be a participating provider, or for the claim to have been assigned.
Important: If you qualify for mental health HPSA bonus payments, you will fall into one of two groups; those who must indicate that a service was rendered in a geographic HPSA when submitting claims using the appropriate modifier, and those who are on the automated zip code file. If the zip code of the facility where the services were rendered is on the automated zip code file, the bonus will automatically be posted to the claim, and then at the end of the quarter, you will receive a bonus payment. For those in the former group, you must indicate that a service was rendered in a geographic HPSA, by using the AQ modifier. The AQ modifier indicates that the physician is providing services in a HPSA.
The automated zip code file is effective for dates of service on or after January 1, 2005. Prior to that time, HPSA eligible services had to be billed with the appropriate modifier.
Please check the CMS Website at http://www.cms.hhs.gov/hpsapsa
physicianbonuses/01_overview.asp? 
to determine whether the HPSA bonus payment will automatically be paid for services rendered in your area. Scroll down the page to the Downloads section and select the Primary Care HPSA file for the appropriate year.
Check these Websites for the following:
Verify Automated HPSA Bonus Designation Status on the CMS Website
http://www.cms.hhs.gov/HPSA
PSAPhysicianBonuses/
Verify HPSA Status on the Health Resources and Services Administration (HRSA) Website
http://www.bhpr.hrsa.gov/shortage/
To bill HPSA services provided at a location other than at the patient's home, the name, address, and zip code of where the service was rendered must appear. This information should be entered in ANSI 4010A1 Loop 2310D 2-250-NM103 (FA, TL, 77, LI) for the electronic HIPAA 4010A1 format. (This would be Item 32 of the CMS 1500 claim form).
Physicians can choose not to receive any HPSA bonus payments on services that would otherwise be eligible. Please contact us if you choose not to receive any bonus payment.
Incorrect use of the HPSA modifier can result in a violation of Medicare law. On a post-payment basis, Medicare will monitor claims submitted with the AQ modifier to verify eligibility for the bonus payment. Please visit the WPS Medicare Website by clicking here for Medicare contact information for questions regarding HPSA.
Page Last Updated: Tuesday, 15-Jul-2008 10:39:22 CDT
