The 2,226 ZIP Codes Medicare Took Off Auto-Pay
CMS opened the 2027 HPSA bonus file on September 15 with CR 14604. Diffing the last three editions shows 2,226 primary care ZIP codes came off the automated list in a single update, 2,017 are still off, and the 10% bonus for 7,025 physicians in them now depends on a modifier the MACs sample.
On September 15 CMS issued a change request whose entire operational content is an instruction to go download a file. Transmittal 13942, CR 14604, four pages, five business requirements, and the 2027 Health Professional Shortage Area bonus cycle is open.
The file it points at decides whether a 10% bonus lands in your remittance every quarter without anybody at your practice doing anything.
It is also the least visible annual update in Medicare Part B. CMS builds it from designations "as close as possible to November 1," hands it to the MACs "in early December," and tells them the retrieval date by email.
"How much does the list move between editions, and who stops getting paid when it does?"
What the File Actually Is
The HPSA physician bonus is 10% of what Medicare actually pays for professional services, settled quarterly, and it rides on where the service was furnished.
Only geographic HPSAs qualify. Population-group and facility designations account for 7,507 of the 9,003 primary medical HPSAs HRSA carried on June 30, so the bonus tracks the other 1,496 and the 41.2 million people inside them.
CMS renders those designations into a flat list of ZIP codes. Land on the list and the MAC pays the bonus automatically.
Fall off it and you are back to appending AQ and hoping your area is at least partially designated, with requirement 14604.4 pointing the Part B MACs at "samples of paid claims submitted with the AQ modifier."
So the list is the whole game. We pulled the last three editions and counted them (chart below).
The 2024 primary care file carried 8,397 ZIP codes, the 2025 edition 6,430, the 2026 edition 7,483.
The net numbers understate it badly.
Going into 2025, 2,226 ZIP codes came off the file and 259 went on. Going into 2026, 46 came off and 1,099 went on.
Mental health moved the same way and harder: 2,908 ZIP codes off for 2025 against 76 on, then 729 on for 2026 against 44 off.
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