KristenB

Contributor
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Easton, PA
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What modifier should be used when a PA performs CPT such as 99213 rather than the MD performing the 99213 in a group practice outpatient setting?

(All insurances, but Medicare in particular)
 

csperoni

True Blue
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Selden
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Medicare does not require a modifier to bill a PA services. Either they are billed under the PA if all requirements for incident to are not met, or under the physician if incident to is met.
I do recall a United Healthcare policy approximately 6 months ago stating -SA modifier should be used on incident to claims. This is the United Healthcare policy: https://www.uhcprovider.com/content...d-Practice-Providers-EM-Procedures-Policy.pdf

Each carrier may have its own policy regarding the use of -SA modifiers. I do not recall any other insurance requiring it. Medicare definitely does not currently recognize -SA.
 

lmkeller

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I'm having a similar issue with Buckeye. I'm assigning an SA modifier to our Physician Assistant's claims and they are denying her claims stating submit with the correct modifier. I reached out to them and they are saying that SA is only used for NP's and that there is another modifier I should be using. I cannot find anywhere what they are looking for. Any advice would help.
 
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