DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for ...

CMS-1503-FC 869
in surgical specialties.
Response: Section 1833(y)(2) of the Act (as added by section 5501(b) of the
ACA) specifically limits HSIP eligibility to those physicians (a doctor of medicine or
osteopathy legally authorized to practice medicine and surgery by the State in which he
performs such function or action according to the definition in section 1861(r)(1)) of the
Act who have designated 02-general surgery as their primary specialty code in Medicare's
physician enrollment. On the other hand, physician assistants are not doctors of medicine
or osteopathy and these practitioners are identified in Medicare enrollment with the
specialty code 97-physician assistant. Therefore, we do not believe we have the statutory
authority to extend HSIP payment to physician assistants who provide surgical support
for major surgeries furnished by general surgeons in recognized HPSAs.
After consideration of the public comments we received, we are finalizing our
CY 2011 HSIP proposal, with modification regarding the proposal to create a new
HCPCS code modifier to identify circumstances when general surgeons furnish services
in areas that are designated as HPSAs as of December 31 of the prior year, but that are
not on the list of zip codes eligible for automatic payment. Under our final policy, under
these circumstances practitioners would report the existing modifier –AQ (Physician
providing a service in a HPSA) that is used for the established Medicare HPSA physician
bonus program because we would make incentive payments under the HSIP for surgical
procedures furnished by general surgeons in the same HPSAs that are recognized for the
Medicare HPSA physician bonus program.
In summary, the HSIP provides a 10 percent incentive payment quarterly to
qualifying physicians enrolled as general surgeons in Medicare (or to the CAHs to which