Physicians furnishing services to Medicare beneficiaries in areas designated as of December 31, 2012 by the Health Resources and Services Administration (HRSA) as primary care geographic Health Professional Shortage Areas (HPSAs) are eligible for a ten percent bonus payment for services furnished from January 1, 2013, to December 31, 2013. If an area does not have a geographic primary care HPSA designation, but does have a geographic mental health HPSA designation, then only psychiatrists furnishing services to Medicare beneficiaries in the designated area are eligible for the ten percent bonus.
It is the responsibility of the physician to determine if a service is furnished in a geographic HPSA. Eligibility is determined annually based on the status of the designation as of December 31 of the prior year.
o A physician or provider that was eligible for the ten percent bonus in 2012 may not be eligible for the bonus in 2013.
o A physician or provider that was not eligible for the ten percent bonus in 2011 may be eligible for the bonus in 2012. Information on designated areas is available from HRSA.
The following websites may be helpful in determining if an area is a geographic primary care or mental health HPSA:
- HRSA website (shows if an area is eligible)
- HRSA website (identifies designations within a state),
- FFIEC website(identifies census tracts by entering an address)
CMS publishes annually a list of ZIP codes for which the ten percent bonus is paid automatically. Only areas where the entire ZIP code falls within the designated area at the time the list is developed are listed.
o Physicians and providers furnishing services in eligible areas that are not on the CMS list of ZIP codes for automatic payment of the bonus must use the AQ modifier to receive the bonus. Only physicians furnishing services in areas designated as of December 31, 2012 as a geographic primary care HPSA whose ZIP code is not on the list should use the modifier.
o Only psychiatrists furnishing services in areas that are not designated as a primary care HPSA as of December 31, 2012 but are designated as a geographic mental health HPSA should use the modifier if the ZIP code is not on the list for automatic payment.
Information on the Medicare Physician bonus program, including the list of ZIP codes eligible for automatic payment of the bonus, can be found on the Physician Bonuses website.