tci Medicare Compliance & Reimbursement - 2017 Issue 19

Non-Physician Practitioners: Append Modifier SA on NPP Claims Now or Risk Denials, One Private Payer Says

Tip: Not all payers require modifier SA for non-physician practitioners performing an E/M. E/M services are amongst the most common claims in healthcare, remaining the bread-and-butter of many Medicare providers’ businesses. But reporting this basic care just got harder under one private payer. You’ll now need to append modifier SA to the E/M code if a non-physician practitioner performed the service and your patient is insured with UnitedHealthcare. The news: According to UnitedHealthcare’s June 2017 Network Bulletin, the payer has a new policy for claims with dates of service on or after Sept. 1, 2017. “UnitedHealthcare...

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