Health Professional Shortage Area (HPSA) Bonus

Qualified providers in medically underserved areas, known as health professional shortage areas (HPSA), are eligible for a HPSA bonus that exceeds the amount normally paid under TRICARE. HPSA areas are designated by the Secretary of Health and Human Services for the Medicare program and include both primary care and behavioral health.

The HPSA bonus payment is 10 percent of the amount actually paid on a TRICARE claim, including instances where TRICARE is the secondary payer.

Important about the HPSA bonus include:

• The bonus payment is based on where the service is rendered, not the beneficiary’s address, and must be within a health professional shortage area.
• Bonus payments are paid on a quarterly basis, not with each claim. In addition, the bonus will be based on what TRICARE actually paid, not on the TRICARE-approved payment amount.
• Providers who qualify for Bonus Payments must use one modifier "AQ" in Box 24D of the CMS-1500 claim form when billing for HPSA Bonus Payments. Note that although Medicare no longer requires the use of modifiers, TRICARE still requires their use.
• Providers who are eligible and do not submit claims with the appropriate modifier will not receive the bonus payment from TRICARE. There are no retroactive payments, adjustments, or appeals for obtaining a bonus payment, so be sure to include the bonus payment modifier with your initial claims submission if you are eligible.

To determine if you are eligible for a HPSA bonus, please go to the U.S. Department of Health and Human Services website regarding HPSA at http://hpsafind.hrsa.gov/and follow the search instructions.

For more information on HPSA designations and modifer usage, please refer to the TRICARE Reimbursement Manual, Chapter 1, Section 33, at http://manuals.tricare.osd.mil/.