tci ED Coding & Reimbursement Alert - 2017 Issue 10

Modifiers: This Major Payer Now Requires Modifier SA on E/Ms Performed by NPPs

When your NP, PA, or CNS performs an E/M, you'll need to append modifier SA when billing UHC. Following the rules for billing non-physician practitioners' services can be tricky, and when you add the state scope of practice laws, incident-to regulations, and other complex issues, reporting these visits can become downright confusing. Unfortunately, one payer is making the process even more challenging by creating new rules for billing E/M services performed by NPPs. At issue: According to United Healthcare's June 2017 Network Bulletin, the payer has a new policy for claims with dates of service on or after Sept...

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