Pulmonology Coding Alert

Question: I'm confused about whether to apply modifier AQ on my claims that qualify for HPSA payments. If our ZIP code is in the health professional shortage area (HPSA) annual file, do I need to use the modifier, or should we leave it off of our claims for these services? Ohio Subscriber Answer: If your ZIP code is included in Medicare's annual file for automated HPSA bonus payment, you should not append modifier AQ (Physician providing a service in an unlisted health professional shortage area) to your claims. Your Medicare contractor will make the bonus payment automatically. 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 HPSA, as identified by Medicare prior to the beginning of such year. CMS posts a file annually of ZIP codes where [...]