Wiki incident-to modifiers when procedures are performed.

[briannah]

I know modifier SA is applied to the E&M code, but I can't find anything for procedures. How do you let the insurance know the PA is performing the procedure under the physicians order on a claim? This is the first time I'm billing for a provider that can't be credentialed with a plan

 

[jkyles]

Hi there, you'll need to research that specific payer's policies to determine whether it has a policy for incident-to services and if so, when and how those services should be billed.

(Just as an aside, you don't report a modifier for Medicare services, but I assume you're talking about a private payer.)

 

[briannah]

Hi there, you'll need to research that specific payer's policies to determine whether it has a policy for incident-to services and if so, when and how those services should be billed.

(Just as an aside, you don't report a modifier for Medicare services, but I assume you're talking about a private payer.)

Yes, private payer. When I asked their requirements they stated they can't advise me how to bill. I didn't want to assume no modifier but couldn't find anything, so wanted to be sure I wasn't missing something. thank you!