The AQ HCPCS modifier should never be submitted to Medicare for these types of non-eligible HPSA. Low income, population, Native American, Inmate, or any other type of HPSA does not qualify for the Medicare HPSA bonus. Only a “GEOGRAPHIC” HPSA is eligible for the Medicare HPSA bonus. No other specialty may add the AQ HCPCS modifier for services rendered in a Mental HPSA The AQ HCPCS modifier for Mental HPSA locations may only be used by Psychiatrists. If you have a question about a HPSA payment, you must submit a written inquiry to Palmetto GBA within 60 days of the date of the original HPSA payment, and include a copy of the Medicare remittance advice The most current source of HPSA designations is the Health Resources Services Administration (HRSA) website: external link If the ZIP code of the location where the services were rendered is not present, check the Palmetto GBA website for HPSA designations to determine if the location where you render services is within a HPSA bonus area, but still requires the submission of HCPCS modifier AQ To determine if you qualify to automatically (based on the rendered service zip code location) receive the bonus payment because the service location ZIP Code falls within a HPSA designated area, review the HPSA ZIP code for the correct year at: external link When a provider travels to a nursing home, hospital or 2nd office which is outside a HPSA those services are NOT eligible for the HPSA bonus, even if the provider’s primary office is within a HPSA designated area Additionally, identified overpayments will be collected on previously paid claims – This situation can drastically impact the cash flow for your office. If Palmetto GBA determines evidence to the contrary, you may begin to receive rejections on future claims submitted with the HPSA AQ HCPCS modifier in error. In adding the HPSA AQ HCPCS modifier to a claim, you are attesting that you have researched external link for Medicare HPSA eligibility and determined that the physical address was a designated HPSA area where and when the services were rendered. Palmetto GBA is experiencing an increase in the number of providers that are submitting claims with the HPSA AQ HCPCS modifier incorrectly. Health Professional Shortage Area (HPSA) – Use of the AQ HCPCS Modifier May Reduce Cash Flow When you provide services in a zip code area that was not included in the automated file of HPSA areas based on the date of the data run used to create the file.
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