Physician

value and occurrence codes) should be directed to the Medicare Contractor.
Inappropriate Medicare payments should be returned to the Medicare Contractor.
Medicare Contractor Contact Information
The Provider Call Center Toll-Free Numbers Directory, which contains Medicare
Contractor contact information, can be accessed in the Downloads Section at
http://www.cms.hhs.gov/MLNGenInfo/30_contactus.asp on the CMS website.
INCENTIVE PAYMENTS
Health Professional Shortage Area Incentive Payment
The Omnibus Budget Reconciliation Act of 1987 established Medicare’s Incentive
Payment Program, which encouraged primary care physicians to work in underserved
rural areas and to improve access to care for Medicare beneficiaries. It paid primary
care physicians an incentive payment of five percent for services furnished to Medicare
beneficiaries in Federally-designated Health Professional Shortage Areas (HPSA).
Effective January 1, 1991, Congress increased the incentive payment to 10 percent and
expanded eligibility to include physicians’ services in both rural and urban HPSAs.
Under Section 1833(m) of the Social Security Act, physicians (including psychiatrists)
who furnish care in an area that is designated as a geographic-based, primary medical
care HPSA and psychiatrists who furnish care in an area that is designated as a
geographic-based mental health HPSA are eligible for a 10 percent HPSA incentive
payment for outpatient professional services furnished to a Medicare beneficiary. The
HPSA incentive payment is available only for the physician’s professional services. If a
service is billed with both a professional and a technical component, only the
professional component will receive the incentive payment. The incentive payment is
based on the paid amount of the claim.
If the service is furnished in an area that is on the CMS list of ZIP codes that are eligible
for the HPSA incentive payment, payments are automatically paid on a quarterly basis.
The list of eligible ZIP codes is updated annually and is effective for services on or after
January 1 of each calendar year. An area may be eligible for the HPSA incentive
payment but the ZIP code may not be on the list because:
1) It does not fall within a designated full county HPSA;
2) It is not considered to fall within the county based on a determination of dominance
made by the U.S. Postal Service;
3) It is partially in a sub-county HPSA; or
4) Services with dates of service on or after January 1, 2009 are provided in a Zip
code area that was designated as of December 31 of the prior year but are not on
the Zip code file.
Medicare Physician Guide: A Resource for Residents, Practicing Physicians and Other Health Care Professionals 37