CMS Pub. 100-04, ch. 12, § 90.4.2

HPSA designations are made by the Health Resources and Services Administration’s (HRSA)

Division of Shortage Designation (DSD). An automated file of areas eligible for the HPSA

bonus payment will be updated on an annual basis and will be effective for services rendered

with dates of service on or after January 1 of each calendar year. Physicians may only use the

AQ modifier for services furnished in an area that was designated as of December 31 of the

prior year. This information can be downloaded from the HRSA Web site.

A/B MACs (B) will be informed of the availability of the file and the file name via an email

notice. A/B MACs (B) will automatically pay bonuses for services rendered in ZIP Code areas

that fully fall within a designated primary care or mental health full county HPSA; are

considered to fully fall in the county based on a determination of dominance made by the

United States Postal Service (USPS); or are fully within a partial county HPSA area. Should a

ZIP Code fall within both a primary care and mental health HPSA, only one bonus will be paid

on the service. Bonuses for mental health HPSAs will be paid when performed by any of the

psychiatry provider specialties.

For services rendered in ZIP Code areas that do not fall within a designated full county HPSA;

are not considered to fall within the county based on a determination of dominance made by

the USPS; or are partially within a partial county HPSA, physicians must submit a AQ

modifier to receive payment.

To determine whether a modifier is needed, physicians must review the information provided

on the CMS Web or the HRSA Web site for HPSA designations to determine if the location

where they render services is, indeed, within a HPSA bonus area. Physicians may also base the

determinations on letters of designations received from HRSA. They must be prepared to

provide these letters as documentation upon the request of the A/B MAC (B) and should verify

the eligibility of their area for a bonus with their A/B MAC (B) before submitting services with

a HPSA modifier.

For services rendered in ZIP Code areas that cannot automatically receive the bonus, it will be

necessary to know the census tract of the area to determine if a bonus should be paid and a

modifier submitted. Census tract data can be retrieved by visiting the U.S. Census Bureau Web

site at www.Census.gov or the Federal Financial Institutions Examination Council (FFIEC)

Web site at www.ffiec.gov/geocode/default.htm. Instructions on how to use these Web sites

can be found on the CMS Web site at http://new.cms.hhs.gov/HPSAPSAPhysicianBonuses.

Neither CMS nor the Medicare A/B MACs (B) can provide information on the functionality of

these Web sites.