Overview of the HSIP


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)

The incentive payment applies to major surgical procedures, that are defined as 10 - and 90 - day global procedures under the Physician Fee Schedule (PFS) and furnished on or after January 1, 2011, and before January 1, 2016, by an 02-general surgeon in an area designated under Section 332(a)(1)(A) of the Public Health  Service Act as a HPSA.


To be consistent with the Medicare HPSA physician bonus program (Pub. 100-04, Chapter 12, §90.4), HSIP payments are calculated by Medicare contractors on a quarterly basis, on behalf of the qualifying general surgeon, for the qualifying surgical procedures. The surgeons’ professional services are paid under the PFS based on a claim for professional services.



HPSA Identification

Implementation: 01-03-11 for the claim identification of the incentive and 04-04-11 for full implementation)

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. Contractors 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.

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