Tuesday, June 5, 2012

Modifier AQ - Amerigroup

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:

CPT Codes  Service Description 

99201 – 99215 
New and established patient office or other outpatient visits 

99304 –

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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