Bonus payments in Health Profession Shortage Areas (HPSA)

Network and non-network physicians (MDs, DOs, podiatrists, oral surgeons and optometrists) who qualify for Medicare bonus payments in HPSAs may be eligible for a 10 percent bonus payment for claims submitted to TRICARE. Behavioral healthcare providers who are eligible for HPSA bonuses are MDs and DOs. Nonphysicians (PhDs, social workers, counselors, psychiatric nurse practitioners and marriage therapists) are not eligible.

Providers can determine if they are in an HPSA using the US Department of Health and Human Services Health Resources and Services Administration’s HPSA search tool at hpsafind.hrsa.gov

View HPSA designations and bonus payment information


Bonus payments calculations

For providers who are eligible and located in an HPSA, WPS will calculate a quarterly 10 percent bonus payment from the total paid amount for TRICARE Prime, TRICARE Prime Remote (TPR), TRICARE Prime Remote for Active Duty Family Members (TPRADFM), TRICARE Select, TRICARE Reserve Select (TRS) and TRICARE Retired Reserve (TRR) claims and the amount paid by the government on Other Health Insurance (OHI) claims.

Please keep in mind the following:

  • The bonus payment is based on the ZIP Code of the location where the service is actually performed, which must be in an HPSA, rather than the ZIP Code of the billing office or other location.
  • As of October 1, 2013, the AQ modifier is no longer required except in those instances where ZIP Codes do not fall entirely within a full county HPSA.
  • When calculating bonus payment for services containing both a professional and technical component, only the professional component will be used.

For information about bonus payments, refer to the TRICARE Reimbursement Manual, Chapter 1, Section 33