How to Claims Coding - HPSA - MODIFIERS


For services with dates of service prior to January 1, 2005, physicians must indicate that their services were provided in an incentive-eligible rural or urban HPSA by using one of the following modifiers:

QB - physician providing a service in a rural HPSA; or

QU - physician providing a service in an urban HPSA.

Effective for claims with dates of service on or after January 1, 2006, the QB and QU modifiers will no longer be accepted. Claims with prior dates of service must still be submitted with those modifiers. The AQ modifier, Physician providing a service in a Health Professional Shortage Area (HPSA), will replace the QB and QU modifiers and will be effective for claims with dates of service on or after January 1, 2006.

For services with dates of service on or after January 1, 2005, the bonus will automatically be paid without the submission of a modifier for the following:

• When services are provided in a zip code area that fully falls within a full county HPSA;

• When services are provided in a zip code area that partially falls within a full county HPSA and has been determined to be dominant for the county by the USPS; and

• When services are provided within a zip code that fully falls within a partial county HPSA.

The submission of the QB or QU modifier, or the AQ modifier for claims with dates of service on or after January 1, 2006, will be required for the following:

• When services are provided in zip code areas that do not fully fall within a designated full county HPSA bonus area;

• When services are provided in a zip code area that partially falls within a full county HPSA but is not considered to be in that county based on the dominance decision made by the USPS;

• When services are provided in a zip code area that partially falls within a partial county HPSA; and.

• When services are provided in a zip code area that was not included in the automated file based on the date of the data run used to create the file.

In order to be considered for the bonus payment, the name, address, and zip code of where the service was rendered must be included on all electronic and paper claims submissions.

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