Network and non-network physicians (M.D.s and D.O.s), podiatrists, oral surgeons, and optometrists who qualify for Medicare bonus payments in Health Professional Shortage Areas (HPSAs) may be eligible for a 10-percent bonus payment for claims submitted to TRICARE. The only behavioral health providers who are eligible for HPSA bonuses are M.D.s and D.O.s. Non-physicians (Ph.D.s, social workers, counselors, psychiatric nurse practitioners, and marriage therapists) are not eligible.

Providers can determine if they are in an HPSA by accessing the U.S. Department of Health and Human Services, Bureau of Health Professions’ HPSA search tool. There is also bonus payment information, including HPSA designations, on the Centers for Medicare and Medicaid Services (CMS) Web site.

For those providers who are eligible and located in an HPSA, Humana Military’s claims processor, PGBA, will calculate a quarterly 10-percent bonus payment from the total paid amount for TRICARE claims that contain the modifier AQ (Health Professional Shortage Area) in Box 24D of the CMS-1500 claim form. Bonus payments will be calculated on TRICARE Prime, TRICARE Prime Remote, TRICARE Prime Remote for Active Duty Family Members, TRICARE Standard, TRICARE Extra, and TRICARE Reserve Select claims and the amount paid by the government on other health insurance (OHI) claims.

When submitting a claim for the bonus payment, providers must include the AQ CPT modifier in Box 24D of the CMS-1500 claim form. For CPT codes with multiple modifiers, place the AQ modifier last. Only the professional component will be used in the calculation of the bonus payment for services that contain both a professional and technical component. Those 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.

Note: Although Medicare no longer requires the use of modifiers, TRICARE still requires their use. If claims are submitted without the modifier, your bonus payment cannot be paid.