US · guidance
CMS Pub. 100-04, ch. 12, § 90.4.11.2
HPSA Identification
For HSIP payments to be applicable, the 10 - or 90 - day global surgical procedure must
be furnished in an area designated by the Secretary as of December 31 of the prior year as
a HPSA.
Each year, a list of ZIP codes eligible for automatic payment of the HSIP incentive
payment (and the Medicare HPSA physician bonus program) is published. This list is
utilized for automatic payments of the incentive for eligible services furnished by general
surgeons. A/B MACs (B) will use the existing HPSA modifier -AQ ,along with the
physician specialty (02), to identify circumstances when general surgeons furnish major
surgical procedures in areas that are designated as HPSAs as of December 31 of the prior
year, but that are not on the list of ZIP codes eligible for automatic payment. Modifier -
AQ should be appended to the major surgical procedure on claims submitted for payment
under these circumstances.
History
(Rev. 2040, Issued: 08-27-10, Effective: 01-01-11 and 04-04-11, Implementation: 01- 03-11 for the claim identification of the incentive and 04-04-11 for full implementation)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
cde020845f5273c41aba1f4874234a65a59c2583258809ea034e9b92ac6f5008
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