When to Use Modifier SA

When to Use Modifier SA

You should use modifier SA Nurse practitioner rendering service in collaboration with a physician for supervised NP services, when the insurer requires the modifier. Medicare does not accept modifier SA, and other payers may specify unique requirements. For example, Blue Cross/Blue Shield Texas calls for modifier SA when a supervising physician bills on behalf of a PA, adult nurse practitioner (ANP), or certified registered nurse first assistant (CRNFA) for non-surgical services (which could include E/M services). Contact your payer for specifics.

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

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John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

6 Responses to “When to Use Modifier SA”

  1. Barbara J. Cobuzzi says:

    United Healthcare has indicated that the SA modifier be used for APP services provided under collaboration, billing under the Physician’s NPI starting 9/1/2017. United Health wants the practice to put the rendering provider’s NPI in box 24J.

  2. Kelly Secreto says:

    “SA” can’t be used for inpatient can it?

  3. Chris Gray says:

    Barbara Cobuzzi ,
    Can you tell me the source you found that the SA modifier is needed for United Healthcare?
    Appreciate your help in this matter. Thank you.

  4. penny says:

    I am very new to the field and currently working in a billing office for multiple practices who use nurse practitioners. Can you clarify for me:
    A NP performs an E/M service, what npi number goes in box 24 j–the nurse practitioner or doctor? I called UnitedHealthCare, and was told no one knows what I am talking about when questioning the sa modifier-

  5. AAPC Toni says:

    Unfortunately, due to liability reasons, we are not able to give out coding or billing advice. However, we have some links posted on our website that might be helpful. They can be found under the “Resources” tab. You can also try one of the following possibilities:

    – Search the member forums to see if someone else has already asked/answered the same question.
    – Post a question in the member forums to see if other coders could help you.
    – Contact your local chapter officers to see if they could help you.

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