When to Use Modifier SA
- By John Verhovshek
- In Coding
- July 24, 2017
- 10 Comments
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, MA, CPC, is a contributing editor at AAPC. He has been covering 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.
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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.
“SA” can’t be used for inpatient can it?
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.
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-
https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/News/June-Interactive-Network-Bulletin-2017.pdf
page 24 states this modifier SA addition.
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.
Does the physician have to be present in order to bill the SA modifier, or do they have to sign the chart for that encounter?
Can 99214 be billed with modifier SA?
In Texas – MD went out of the country and is providing supervision / collaborating through telephonic means (Phone, EMR). He has access to eMr and NP is providing services to patients. H wants to bill insurance under his NPI with SA modifier to capture at in network level. There is question that the payers may not allow this since he is out of the country. Only UHC states the physician is ‘presumably’ on site, but no criteria stating otherwise or distance requirement. Other payers typically accept the SA modifier during credentialing. Since Texas is an independent state for APN prescriptive authority, would it be advisable to bill the payers with SA modifier in his absence? NP would bill Medicare under own NPI as per incident to guidelines.
should we use modifier SA when NP bills Urodinamic study tests like 51741 under doctor’s supervision.