Health Professional Shortage Area: Eligibility for Incentive Payments
Professional services performed by certain providers are eligible for a 10 percent bonus payment when the services are rendered in a Health Professional Shortage Area (HPSA). Following are some important points to keep in mind when determining if a service is eligible for the HPSA bonus:
- Services rendered in geographic HPSA's (Primary Care) and Mental Health HPSA's are eligible to receive the Medicare 10 percent incentive bonus
- If a service is rendered in a location that is both Geographic HPSA and Mental Health HPSA, only a single 10 percent bonus will be paid
- Physicians who are M.D., D.O., D.C., D.P.M. and O.D. are eligible to receive the Geographic HPSA Bonus
- Psychiatrists, specialties 26 and 86, are eligible to receive the Mental Health Bonus
- Only professional services qualify for the HPSA bonus
- Eligibility for the incentive 10 percent bonus is based on where the service is actually performed and not where the physician or patient reside
Submitting HPSA modifiers for services that do not qualify for the incentive payment could result in incentive payments being sent to you in error. It is vital that you determine whether the service qualifies for a HPSA bonus payment prior to submitting the claim. Palmetto GBA monitors incentive payments, and we are required to collect any incorrect payments that we identify.
The date of HPSA designation or withdrawal may be obtained at the Health Resources Services Administration (HRSA) Web site: http://hpsafind.hrsa.gov. Please routinely review the HRSA database for changes since it is updated weekly and provides the most current information. When reviewing the HRSA database the 'Advanced Search Feature' of the database must be used to obtain correct HPSA information. The 'Advanced Search Feature' may be accessed by clicking the 'Advanced search by HPSA Type, Score, Metro and Status' link located at the top right hand side of the HRSA database.
Note: Census Tract (C.T.) is a small geographical area established by local committees and approved by the Census Bureau. Census Tracts contain a population segment with relatively uniform economic and social characteristics and clearly identifiable boundaries averaging approximately 1,200 households.
'Opt Out' reminder:
'Effective for claims received on or after October 1, 2005, upon notification from physicians that they do not want to receive bonuses on ANY eligible HPSA or PSA services, carriers and standard systems shall make accommodation in their systems so those physicians shall receive no bonus payments.' For additional information see Medlearn Matters article for CR 3822 and CR 3827.
If you need additional clarification or have any concerns regarding the HPSA program (Geographical or Mental Health areas), please contact our Part B Provider Contact Center at (866) 332-7025.