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Printed Date: 9/22/2015
Providers are encouraged to review the service location before appending the AQ modifier to receive the HPSA incentive bonus. In adding the HPSA AQ HCPCS modifier to a claim, you are attesting that you have researched www.hrsa.gov for Medicare HPSA eligibility and determined that the physical address was a designated HPSA area where and when the services were rendered. If Palmetto GBA determines evidence to the contrary, you may begin to receive rejections on future claims submitted with the HPSA AQ HCPCS modifier in error. Additionally, identified overpayments will be collected on previously paid claims. This situation can drastically impact the cash flow for your office.
Please note: Incentive payments paid in error are subject to overpayment collection following the standard recoupment process. Providers that continue to incorrectly bill using the HPSA AQ HCPCS modifier are at risk of being referred to Benefit Integrity for fraudulent billing.
Date of Service (DOS)
Dates of service are also extremely important in determining HPSA eligibility. HPSA locations for Medicare payments purposes (may) change each January 1. Therefore, even if you determine that your location became eligible during a year, you cannot begin using the AQ HCPCS modifier until January 1 of the following year.
For example, an address becomes a HPSA designated area on July 1, 2014. Any services rendered at that address are not eligible for the HPSA 10 percent bonus until January 1, 2015.
Similarly, if the HPSA location is removed at any point during a year, Medicare will continue to pay the HPSA bonus until December 31 of that year. Refer to MLN CR 6106 (PDF, 270 KB) at for complete details regarding dates of eligibility.
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Last Updated: 12/09/2019