Physician Bonuses

What Are Physician Health Professional Shortage Area Bonuses?

The Health Resources & Services Administration (HRSA) designates some geographic areas as Health Professional Shortage Areas (HPSAs). HPSAs are geographic areas that don’t have enough health care providers to meet the health care needs of the area’s population. Medicare pays a 10% quarterly bonus to certain health care providers who furnish services in these areas.

We base the 10% bonus on the amount that the patient pays for professional services, not the Medicare-approved amount for each service.
The HPSA bonus applies only to a physician's professional services. If you bill for a service that has both a professional and technical component, you’ll only get a bonus for the professional component.

Who Can Get an HPSA Bonus?

You’re eligible to get an HPSA bonus if you’re a:

Physician who furnishes Medicare-covered medical services in a primary medical care HPSA
Psychiatrist who furnishes Medicare-covered services in a mental health HPSA

The HPSA bonus is based on where you provide the service, not where the patient lives or your primary office location. So, you’re eligible to get the bonus when you provide the service in an HPSA.

When you submit the claim, you must include the name, address, and ZIP code of the location where you provided the service
If you provide the service in a location that’s within both a primary medical care and mental health HPSA, Medicare will only pay 1 bonus on the service

Do I Need to Use a Claims Modifier?

You don’t need to include a modifier on the claim, and you’ll get the HPSA bonus payment automatically, if you provide the services in any of these:

A ZIP Code that falls entirely in a county designated as a full-county HPSA
A ZIP Code that falls partially within a full-county HPSA, but is considered to fall entirely within the county based on a United States Postal Service (USPS) determination of dominance
A ZIP Code that falls entirely within a partial-county HPSA

You do need to include the AQ modifier on claims to get the HPSA bonus payment if you provide the services in ZIP Codes that don’t meet the criteria listed above. For example, you must include the AQ modifier when you provide services in a ZIP Code area that:

Doesn’t fall entirely within a designated full-county HPSA bonus area
Falls partially within a full-county HPSA, but isn’t considered to be in that county based on the USPS dominance decision
Falls partially within a non-full-county HPSA
Wasn’t included in the automated file of HPSA areas based on the date of the data run used to create the file

Before you submit a claim with the AQ modifier, you should check to be sure the ZIP code is in an HPSA. Medicare may review claims with the AQ modifier to validate the location.

How Do I Find HPSA ZIP Codes?

Check the Primary Care or Mental Health HPSA list:

2024 HPSA Lists

2023 HPSA Lists

2022 HPSA Lists

If the ZIP Code where you provided the service is on the list:
- You’ll automatically qualify to get the bonus payment
- You don’t need to include a modifier on the claim
If the ZIP Code isn’t on the list, use the street address to check HRSA’s Medicare Physician Bonus Payment Eligibility Analyzer. If the address is in a geographic HPSA:
- You’re eligible to get the bonus payment, but you won’t get it automatically
- Include the AQ modifier on the claim

Questions?

For questions about HPSA designations, contact HRSA. Include the full address of the location you’re asking about.
For any other questions about the HPSA bonus program, contact your Medicare Administrative Contractor (MAC).