Following the annual update to a list of health professional shortage areas (HPSAs), physicians can now assess their eligibility for a 10% quarterly bonus from the Centers for Medicare & Medicaid Services.
The bonus is earned by physicians, including psychiatrists, who provide primary care or mental health services to Medicare patients in geographic areas that lack enough health care professionals to meet the needs of their populations. Physicians who provided care to patients in HPSAs before the end of last year are eligible for the Medicare bonus in 2025.
To assess eligibility, physicians can check CMS’ primary care or mental health HPSA lists. If the ZIP code where they provided the service is on the list:
- They’ll automatically qualify to get the bonus payment; and
- They don’t need to include a modifier on the claim.
If the ZIP code isn’t on the list, physicians should use the street address to check HRSA’s Medicare Physician Bonus Payment Eligibility Analyzer. If the address is in a geographic HPSA:
- They will be eligible to get the bonus payment, but won’t get it automatically; and
- They should include the AQ modifier on the claim.
To explore geographic areas, populations, and facility HPSA designations data for primary care, dental health, and mental health throughout the country, visit HRSA’s designation tool.
Gary J. Sheppard, MD, chair of the Texas Medical Association’s Council on Socioeconomics, said the bonus is an “important” boon to physicians burdened by Medicare payment cuts. In December, Congress failed to heed TMA and others in organized medicine’s pleas to avert the 2.8% cut in Medicare physician payments that started Jan. 1.
“Our rates are constantly being cut by Medicare,” Dr. Sheppard said. “This impacts every physician, but especially those providing care in rural and underserved areas, often without support.”
The HPSA bonus is based on where a physician provides the service, not where the patient lives or the location of the primary office.
Moreover, the HPSA bonus applies only to physicians’ professional services; if a physician bills for a service that has both a professional and technical component, they’ll only receive a bonus for the former. CMS will pay only one HPSA bonus if an area has both a primary care and a mental health geographic HPSA designation.
Physicians must include the patient’s name, address, and the ZIP code of the location where they provided the service in all claims.
“This will hopefully provide some relief to physicians caring for Texas patients in [vulnerable] areas of the state,” Dr. Sheppard said.
To speak directly with TMA billing and coding staff, visit TMA’s comprehensive Physician Payment Resource Center. For questions about HPSA designations, contact HRSA, and 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.
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469