Frequently Asked Questions

For an international medical graduate who completed U.S. graduate medical education or training in J-1 status and is subject to INA §212(e), an approved J-1 waiver excuses the otherwise applicable requirement to spend an aggregate of two years physically present in the country of nationality or last residence. The waiver does not itself grant work authorization or immigration status. For Conrad 30 cases, the required service is performed in H-1B nonimmigrant status after USCIS approves the employer’s H-1B petition.

The Conrad State 30 program permits each designated state public health department, or its equivalent, to request up to 30 waivers per federal fiscal year for eligible J-1 physicians who received graduate medical education or training in the United States. In exchange, the physician must agree to practice full-time in the U.S. in H-1B status for at least three years and begin the approved employment within 90 days of receiving the waiver. State sponsorship, a favorable Department of State recommendation, USCIS waiver approval, and approval of the employer’s H-1B petition are separate steps.

No. Meeting the applicable federal site or service-area requirements does not guarantee state sponsorship, a favorable Department of State recommendation, or final USCIS approval. States establish their own priorities, procedures, deadlines, and selection criteria, and may recommend only up to 30 Conrad 30 waiver requests per federal fiscal year.

A physician generally must have been admitted in J-1 status for U.S. graduate medical education or training and must have completed, or be completing, that program. The physician must have a signed contract for full-time medical practice in H-1B status for at least three years with an eligible facility; satisfy the applicable shortage-area, underserved-population, licensing, and state requirements; and begin employment at the named facility within 90 days after receiving the waiver. State sponsorship, a favorable DOS recommendation, and USCIS approval are also required.

A physician cannot self-sponsor a Conrad waiver at the federal level. The designated state health department, or equivalent, must agree to sponsor the physician and transmit the state’s waiver request to DOS. The employer and physician usually work together, often with immigration counsel, to prepare the state application, but the sponsoring state’s rules control the requirements.

In a standard Conrad State 30 case, the physician generally must work full time at a qualifying health care facility in a federally designated HPSA or MUA/MUP, subject to state rules. A state may use up to 10 of its 30 annual slots for qualifying physicians at facilities outside those areas if the facility demonstrates that it serves patients who reside in a federally designated shortage area. These are commonly called Flex 10 cases.

No. The Conrad State 30 program is not federally limited to primary-care physicians; both primary-care physicians and specialists may be considered. Each state establishes its own priorities and may favor primary care, specified specialties, rural practice sites, high-need communities, or facilities serving underserved patients.

A Conrad physician must contract to practice medicine full time—40 hours per week—for at least three years in H-1B status at the approved facility and practice site or sites. Employment must begin within 90 days after receiving the waiver. Material changes during the service period may require USCIS notification, state approval, or a new or amended H-1B petition.

No. A J-1 waiver and H-1B classification are separate immigration actions. The waiver removes the two-year foreign-residence requirement; it does not itself grant work authorization or H-1B status. The employer generally must file Form I-129 with USCIS before the physician begins H-1B employment.

No. A physician who receives H-1B classification based on an approved Conrad State 30 waiver is exempt from the annual H-1B numerical cap and regular H-1B registration selection. The employer must still file an approvable H-1B petition and meet all specialty-occupation, wage, Labor Condition Application, licensing, credentialing, and immigration requirements.

A typical case involves securing a qualifying position, confirming the practice arrangement, completing Form DS-3035, submitting the DOS package and state-specific Conrad 30 application, obtaining state sponsorship, arranging any required No Objection Statement, receiving DOS and USCIS decisions, and obtaining H-1B classification through the employer’s Form I-129 petition. Requirements and sequence can vary by state and may change.

The U.S. Department of State charges a nonrefundable J-1 waiver processing fee, currently $120. Your sponsoring state may charge its own application fee. USCIS filing fees, premium processing, attorney fees, credentialing, and licensing costs may also apply. Fees change, so confirm every amount on the official agency websites immediately before filing.

Attorney representation is not universally required, but a Conrad 30 case can involve state requirements, DOS procedures, USCIS waiver and H-1B filings, Department of Labor requirements, licensing, credentialing, and contract obligations. Consultation with a qualified U.S. immigration attorney experienced in physician waivers and H-1B matters is commonly advisable.

The HPSA bonus is a 10% incentive payment added to Medicare’s physician fee schedule payment for eligible professional services furnished in a designated geographic Health Professional Shortage Area.

Covered professional services billed under the Medicare Physician Fee Schedule are generally eligible. The PC/TC indicator identifies which service codes qualify. Services must be furnished to Medicare beneficiaries in a designated geographic HPSA.

Eligibility depends on whether the location where you furnish services is designated as a geographic HPSA as of December 31 of the prior year. CMS also publishes an automated ZIP-code file for providers who do not need to add a modifier to claims.

CMS pays a 10% bonus on the amount Medicare actually pays for eligible professional services. The calculator multiplies your estimated annual Medicare-paid amount by 10%. If you entered an optional paid-to-allowed ratio, it first converts your allowed amount into an estimated paid amount. CMS pays the bonus quarterly, so the results also show an approximate quarterly figure.

An area can carry more than one HPSA designation. Physicians qualify for the bonus in geographic primary care HPSAs. Psychiatrists qualify in geographic primary care HPSAs and also in geographic mental health HPSAs. If an area has both designations, a psychiatrist receives only one 10% bonus for a given service.

Some ZIP codes split across full- and partial-county HPSA boundaries. Our tool identifies whether your location falls within a designated HPSA, but you should verify exact billing requirements with your MAC or CMS’s published bonus ZIP-code list.

No. HPSA Finder is an independent tool and is not affiliated with, endorsed by, or operated on behalf of HRSA, CMS, or any government agency. Always verify designation status and bonus eligibility through official HRSA and CMS resources.

The bonus applies to physicians furnishing covered professional services in a geographic primary-care HPSA, and to psychiatrists, who qualify in geographic primary-care HPSAs and also in geographic mental-health HPSAs. Dental HPSA designations do not trigger the Medicare bonus payment.

HRSA updates its shortage-area designations periodically, and this tool queries HRSA’s live GIS MapServer. Designations can change, so confirm current status through the official HRSA HPSA Find Tool before relying on a result for billing decisions.

The HPSA score reflects the severity of a provider shortage. Primary care and mental health HPSAs are scored from 0 to 25, and dental HPSAs from 0 to 26. A higher score means greater need. Scores do not affect the Medicare bonus amount, but many programs, including some state Conrad 30 programs, use them to prioritize sites.