Claims Coding Requirements

90.5.3 - Claims Coding Requirements (Rev. 280, Issued 08-13-04, Effective/Implementation: October 1, 2004 for the analysis and design phases for the MCS Maintainer and A/B MACs (B) January 1, 2005 for the coding, testing, and implementation phases for the MCS Maintainer and A/B MACs (B) January 1, 2005 for all phases for the VIPS Maintainers and A/B MACs (B)) Medicare will automatically pay the physician scarcity bonus on a quarterly basis for services provided in ZIP code areas that fully fall within a county designated as a PSA, partially fall within a county designated as a PSA area and are considered to be dominant for that county based on a determination by the United States Postal Service (USPS), or fall within a rural census tract of a metropolitan statistical area identified through the latest modification of the Goldsmith Modification that is determined to be a PSA. In some cases, a service may be provided in a county that is considered to be a PSA, but the ZIP code is not considered to be dominant for that area. The bonus payment cannot automatically be made. In order to receive the bonus for those areas, physicians must include the following modifier on the claim: AR - Physician providing service in a Physician Scarcity Area. In order to be considered for the bonus payment, the name, address, and ZIP code of where the service was rendered must be included on all electronic and paper claims submissions.