Procedure Codes Eligible for the HPSA/PSA Bonus Payments
Information in the Professional Component/Technical Component (PC/TC) indicator field of the Medicare Physician Fee Schedule Database (MPFSDB) is used to identify professional services eligible for Health Professional Shortage Area (HPSA) and Physician Scarcity Area (PSA) bonus payments. Please remember, services rendered by non-physician practitioners are not eligible for a bonus payment.
You can find the PC/TC indicator by accessing the Centers for Medicare & Medicaid Services (CMS) Website at:
http://www.cms.hhs.gov/PFSlookup/ 
Compare the PC/TC indicator to the chart listed below to determine if the procedure code is eligible for the bonus payment.
|
PC/TC Indicator | Bonus Payment Policy |
| 0 | Eligible for HPSA/PSA payment |
| 1 | Globally billed service. Eligible for the professional component only. See information listed below. |
| 2 | Professional component only. Eligible for HPSA/PSA payment |
| 3 | Technical component only. Not eligible for HPSA/PSA payment |
| 4 | Global test only. Only the professional component qualifies for the bonus payment. See information listed below. |
| 5 | Incident to codes. Not eligible for HPSA/PSA payment |
| 6 | Laboratory physician interpretation codes. Eligible for HPSA/PSA payment |
| 7 | Physical therapy service. Not eligible for HPSA/PSA payment |
| 8 | Physician interpretation codes. Eligible for HPSA/PSA payment |
| 9 | Concept of PC/TC does not apply. Not eligible for HPSA/PSA payment |
Prior to October 1, 2005, HPSA/PSA eligible services billed globally with a PC/TC indicator of 1 were returned as unprocessable. The service had to be split between the professional (26 modifier) and technical (TC modifier) components.
Effective for claims received on or after October 1, 2005, procedure codes with a PC/TC indicator of 1 no longer require billing the professional and technical components separately. The incentive payment will be based on the professional component payment amount.
Prior to July 1, 2006, HPSA/PSA eligible services billed with a PC/TC indicator of 4 were returned as unprocessable. These services have separate procedure codes for the professional and technical components.
Effective for claims received on or after July 1, 2006, procedure codes with a PC/TC indicator of 4, except 93015, no longer require billing the professional and technical components separately. The incentive payment will be based on the payment amount for the associated professional component code.
Since 93015 has two associated professional components, we will not be able to make a determination as to which would be the correct component to use to calculate the bonus. Therefore, claims submitted with this code will be returned as unprocessable. The services must then be resubmitted as separate components in order to receive the bonus on the appropriate professional component.
NOTE: Codes that have a status of "X" on the MPFSDB have been assigned PC/TC indicator 9 and are not considered physician services for MPFSDB payment purposes. Therefore, neither the HPSA nor the PSA bonus payment will be paid for these codes.
Anesthesia codes (CPT codes 00100 through 01999) do not appear on the MFSDB. However, when a medically necessary anesthesia service is furnished within a HPSA or PSA by a physician, a HPSA and/or PSA bonus is payable.
To claim a bonus payment for anesthesia, physicians bill codes 00100 through 01999 with modifiers QY, QK, AD, AA, or GC to signify that the anesthesia service was performed by a physician along with the QB, QU, AQ and/or AR modifier when required.
Page Last Updated: Wednesday, 26-Mar-2008 10:25:30 CDT
