2019 Annual Medicare Update for the Health Professional Shortage Area (HPSA) Bonus Payments

Section 413(b) of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 mandated an annual update to the automated HPSA bonus payment file. The Centers for Medicare & Medicaid Services (CMS) automated HPSA ZIP code file are populated using the latest designations as close as possible to November 1st of each year. The HPSA ZIP code file shall be made available to the MACs in early December of each year. MACs shall implement the HPSA ZIP code file and for claims with dates of service January 1st to December 31st of the following year and make automatic HPSA bonus payments to physicians providing eligible services in a ZIP code contained on the file.

You should review the Physician Bonuses webpage at each year to determine whether you need to add modifier AQ to your claim in order to receive the bonus payment, or to see if the ZIP code in which you rendered services will automatically receive the HPSA bonus payment.