Health Professional Shortage Area Bonuses
In keeping with Centers for Medicare & Medicaid Services (CMS)
guidelines, effective July 1, 2012, we will no longer automatically
reimburse our contracted providers for the Health Professional Shortage
Areas (HPSA) bonus.
What this means to you:
Please review the CMS website,
http://datawarehouse.hrsa.gov/GeoAdvisor/ShortageDesignationAdvisor.aspx,
to validate you are within a service area that qualifies for the HPSA
bonus. If you are within the designated service area and eligible for an
HPSA bonus, please contact your Provider Relations representative for
recontracting consideration.
What is the impact of this change?
Participating providers who bill Amerigroup with an AQ modifier for
one of the Current Procedural Terminology (CPT) codes listed below will
no longer automatically receive HPSA bonus payments for the following
evaluation and management services:
About the Health Professional Shortage Areas bonus
HPSAs are geographic areas or populations within geographic areas
that lack sufficient health care providers to meet the needs of the
population. Areas are designated as HPSAs by the Health Resources &
Services Administration based on census tracks, townships or counties.
Designations are made for primary care, dental and mental health
providers.
In keeping with Centers for Medicare & Medicaid Services (CMS)
guidelines, effective July 1, 2012, we will no longer automatically
reimburse our contracted providers for the Health Professional Shortage
Areas (HPSA) bonus.
What this means to you:
Please review the CMS website,
http://datawarehouse.hrsa.gov/GeoAdvisor/ShortageDesignationAdvisor.aspx,
to validate you are within a service area that qualifies for the HPSA
bonus. If you are within the designated service area and eligible for an
HPSA bonus, please contact your Provider Relations representative for
recontracting consideration.
What is the impact of this change?
Participating providers who bill Amerigroup with an AQ modifier for
one of the Current Procedural Terminology (CPT) codes listed below will
no longer automatically receive HPSA bonus payments for the following
evaluation and management services:
| CPT Codes | Service Description |
| 99201 – 99215 | New and established patient office or other outpatient visits |
|
99304 – 99340 |
Nursing facility care visits and domiciliary, rest home or home care plan oversight services |
| 99341 – 99350 | Patient home visits |
About the Health Professional Shortage Areas bonus
HPSAs are geographic areas or populations within geographic areas
that lack sufficient health care providers to meet the needs of the
population. Areas are designated as HPSAs by the Health Resources &
Services Administration based on census tracks, townships or counties.
Designations are made for primary care, dental and mental health
providers.
General surgeons who provide 10- or 90-day global surgical procedures
in a designated HPSA are also eligible for the 10 percent HPSA bonus
and an additional 10 percent HPSA surgical incentive bonus.
What if I need assistance?
If you have questions about this communication, received this fax in
error or need assistance with any other item, contact your local
Provider Relations representative or call Provider Services at
1-866-805-4589.
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