Wiki APRN billing incident to

[kelliem]

We are receiving denials for our APRN's when billing for CPT code 99214 under our MD stating, "Not a clean claim. Medical records received do not match Rendering Provider Name for DOS billed. Resubmit with correct medical records". Should we be using the SA modifier OR should we be billing under the APRN's credentials?

 

[thomas7331]

We are receiving denials for our APRN's when billing for CPT code 99214 under our MD stating, "Not a clean claim. Medical records received do not match Rendering Provider Name for DOS billed. Resubmit with correct medical records". Should we be using the SA modifier OR should we be billing under the APRN's credentials?

Unless this is a Medicare patient, you'll need to find out what this particular payer's policy is with regard to 'incident to' billing. Not all payer allow services to be billed under a supervising provider.