Payment Matters: Second Year of the Medicare Primary Care Provider HPSA Bonus Payment Policy


A recent Medicare Learning Network Matters [PDF] release notified primary care physicians of their potential eligibility for the Health Professional Shortage Area (HPSA) bonus payments. This 10% bonus is available to primary care providers as part of the federal Patient Protection and Affordable Care Act until December 31, 2015.

As previously reported in more detail in "Primary Care Providers and General Surgeons Benefit from Increase Reimbursement", an eligible primary care provider may receive the 10% bonus payment on claims for primary care services that are provided in a HPSA. A primary care provider is eligible if the provider has enrolled in Medicare as a primary care provider and has billed 60% or more of the provider’s HCPCS codes in the previous two years to designated primary care codes. Eligible primary care providers include non-physician providers who bill directly to Medicare and not as “incident-to” a physician’s services.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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