This December, CMS will notify each Medicare Administrative Contractor of the applicable 2016 zip codes that qualify as a Health Professional Shortage Area. Claims submitted Jan. 1 to Dec. 31, 2016 for services in an shortage area will be eligible for a bonus. The bonus applies to professional component of services performed in that zip code area, not the technical component. When you own the equipment and perform the test, no need to bill –TC and -26 components separately.

The bonus could be automatic, but you should append modifier –AQ to the claim in any case when the physician provides services:

• In zip-code areas that do not fall entirely within a designated full county HPSA bonus area;
• In a zip code area that falls partially within a full county HPSA but is not considered to be in that county based on the USPS dominance decision;
• In a zip code area that falls partially within a non-full county HPSA;
• 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

Check your MAC for a listing of the zip codes. Learn more about HPSA bonus payments.