tci E/M Coding Alert - 2016 Issue 7

Reader Question: Check Payers' Policies on Modifier SA

Question: We employ a nurse practitioner (NP) at our office. When she provides supervised services, should we append modifier SA? Our insurer just denied a claim because we didn’t include it; we’ve never heard of it. Connecticut Subscriber Answer: You should use HCPCS Level II modifier SA (Nurse practitioner rendering service in collaboration with a physician) for supervised nurse practitioner services when the insurer requires the modifier. For instance, some Medicaid programs require you to apply modifier SA to all nurse practitioner (NP) services you code under the physician’s national provider identifier (NPI) — also known...

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