Health Professional Shortage Areas (HPSA)
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 Health Professional 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 furnishing services in a geographic, primary care HPSA are eligible to receive bonus payments. Eligible providers include medical doctors, including psychiatrists, doctors of osteopathy, dentists, doctors of podiatric medicine, licensed chiropractors, and optometrists. In addition, psychiatrists furnishing services in a geographic, mental health HPSA are also eligible to receive a bonus payment. To read about mental health HPSA, click here. Non-physician practitioners, such as physician assistants and nurse practitioners, 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 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 modifiers listed below, 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 one of the modifiers listed below:
QB - Physician providing services in a rural HPSA (dates of service prior to 1/1/06)
QU - Physician providing services in an urban HPSA (dates of service prior to 1/1/06)
AQ - Physician providing services in a HPSA (dates of service on or after 1/1/06)
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.
On a post-payment basis, Medicare will monitor claims submitted with the modifiers listed above to verify eligibility for the bonus payment.
Please check the CMS Website at http://www.cms.hhs.gov/hpsapsaphysicianbonuses/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
- Verify HPSA Status on the Health Resources and Services Administration (HRSA) Website
Physicians can choose not to receive any HPSA or PSA 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 modifiers can result in a violation of Medicare law. Please click here for Medicare Part B contact information to verify that a physician is providing services in a designated geographic HPSA.
Page Last Updated: Wednesday, 26-Mar-2008 10:25:30 CDT
