Medicare will automatically pay the bonus without the need for a modifier on the claim for services provided in zip code areas that:

1. Fall within a county designated as a PSA; or
2. Fall partially within a county designated as a PSA and are considered to be dominant in that county, based on a determination of the U.S. Postal Service; or
3. Fall within a rural area 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 a PSA, but the zip code is not considered to be dominant for that area. In these cases the bonus payment cannot be made automatically. To receive the bonus for such services, physicians will need to include the new modifier of AR to reflect a physician service provided in a PSA.

Services submitted with modifier AR will be subject to validation by Medicare.

Zip codes eligible for automatic payment of the physician scarcity bonus are posted on the CMS Web site at www.cms.hhs.gov/HPSAPSAPhysicianBonuses/.