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Wiki APRN billing

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bbates

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Tulsa, OK
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When billing 99214 under the APRN's credentials is there a certain modifier required with that 99214? I have a clinic that has been billing 99214 under their MD and the claims have been denying stating, "Not a clean claim. Medical records received do not match Rendering Provider Name for DOS billed. Resubmit with correct medical records".
Should they be using the SA modifier OR should they be billing under the APRN's credentials?
 
If the APP performed the visit and it is not an incident-to service, it should be billed under the APP's identifier. It if was incident-to, the plan may require the SA modifier. If your employer doesn't have a policy for when and how to use of the SA modifier, I recommend looking up the policy for Advanced Practitioner billing for the plan to see how they want those claims handled.
 
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