Healthcare HPSA modifiers

Health Professional Shortage Areas


In 1988 Medicare began offering incentives to physicians who render services in medically deprived areas. Health Professional Shortage Areas (HPSA s) are divided into 2 types or classifications - urban and rural. The United States Public Health Service determines the location and type of HPSAs in each state. The listing of HPSAs follows below. A detailed address listing of any split HPSA county can be obtained by writing the Provider Service Center.

Qualifications for HPSA incentives are determined by where the services were actually rendered. Physicians whose offices are not located in a HPSA may still be eligible for incentives if they render services in nursing homes or clinics which are located in a HPSA. HPSA incentive payments are made for professional services. Technical services, drugs and supplies are not eligible for HPSA incentive payments. If you perform both the technical and professional portion of a procedure, then you need to split the services on to separate lines on the claim form to collect the incentive bonus on the professional service. Example: A patient has a chest x -ray. You bill code 7102026QB on one line and 71020TC on the second line. HPSA bonus payments are made separately from claim payments and are equal to ten percent of the Medicare payments made on all HPSA claims submitted by a specific physician or medical group during a specific fiscal quarter.

FILING HPSA CLAIMS - In order for Medicare to calculate correct incentives, all eligible claims must be submitted with the correct modifier on all eligible services.

HPSA CLASS MODIFIER

Rural QB

Urban QU

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