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 [...]