MLN Matters Number: MM6106
Related Change Request (CR) #: 6106
Related CR Release Date: November 21, 2008
Effective Date: January 1, 2009
Related CR Transmittal #: R1639CP
Implementation Date: January 5, 2009
Provider Types Affected
Physicians and providers submitting claims to Palmetto GBA for services provided to Medicare beneficiaries in areas designated as geographic HPSAs.
Provider Action Needed
This article is based on Change Request (CR) 6106 and informs providers who are serving Medicare beneficiaries in areas that were eligible on December 31 of the prior year for the HPSA bonus but not on the automated ZIP code list to use the AQ HCPCS modifier to receive the HPSA bonus payment. Make sure billing staff are aware of the clarified criteria for proper use of the AQ HCPCS modifier.
Background
The Section 1833(m) of the Social Security Act provides for an additional 10 percent bonus payment for physicians’ services furnished to a covered individual in an area that is designated as a geographic HPSA prior to the beginning of the year in which the services were provided. Such HPSA areas are identified by the Secretary of the Department of Health and Human Services prior to the beginning of such year. The Centers for Medicare & Medicaid Services (CMS) posts a file annually of ZIP codes within which the HPSA bonus payment should be made automatically. Physicians furnishing services in areas that were eligible for the HPSA bonus prior to the beginning of the year but not on the automated list have been instructed to use the AQ modifier to receive the HPSA bonus payment.
Key Points
- Effective for claims with dates of service on or after January 1, 2009, only services furnished in areas that are designated as geographic HPSAs as of December 31 of the prior year are eligible for the HPSA bonus payment
- Services furnished in areas that are designated at any time during the current year will not be eligible for the HPSA bonus payment until the following year, provided they are still designated on December 31
- If you are providing services to Medicare beneficiaries in areas that are designated on December 31 of the prior year but not included on the list of zip codes eligible for automated HPSA bonus payments make certain you use the AQ HCPCS modifier to receive the HPSA bonus payment
- Remember, your Medicare Contractor will automatically make a HPSA bonus payment to physicians providing eligible services in a ZIP code included in the annual file
Additional Information
For complete details regarding this Change Request (CR) please see the official instruction (CR 6106) issued to your Medicare A/B MAC, carrier or FI. That instruction may be viewed by going to www.cms.hhs.gov/Transmittals/downloads/R1639CP.pdf (PDF, 177 KB).
If you have questions, please contact our Provider Contact Center at our toll free number, (866) 332-7025 (Ohio/West Virginia) or (888) 828-2092 (South Carolina).
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.