Neurology & Pain Management Coding Alert

Question: I'm confused about whether to apply modifier AQ on my claims. If our ZIP code is in the HPSA annual file, do I need to use the modifier?

Washington Subscriber

Answer: If your ZIP code is included in Medicare's annual file for automated HPSA bonus payment, you shouldn't report modifier AQ (Physician providing a service in an unlisted health professional shortage area [HPSA]). Your Medicare contractor will make the bonus payment automatically.

Background: The Social Security Act provides for an additional 10 percent bonus payment for physicians' services furnished in a year to a covered individual in an area that is designated as a geographic Health Professional Shortage Area (HPSA), as identified by Medicare prior to the beginning of such year. CMS posts a file annually of ZIP codes where the HPSA bonus payment should be made automatically.

When to use AQ: Effective since Jan. 1, 2009, coders in areas "eligible on December 31 of the prior year for the HPSA bonus but not on the automated ZIP code list" should use modifier AQ to receive the HPSA bonus, according to MLN Matters article MM6106. You can view the article at www.cms.hhs.gov/mlnmattersarticles/downloads/MM6106.pdf.

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.