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SA modifier for BCBSM

L

lamarch20

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Location
Chesterfield, MI
Hello all,
BCBS Michigan (not sure about other states) is supposedly phasing in major changes to incident-to-billing starting September 1st. I believe we must start using SA modifier for nurse practitioners. Has anyone else heard of this? We are just now starting to bill for a nurse practitioner and was looking for any guidance someone may have. Any classes or videos for billing nurse practitioners would also be appreciated. Thank you.
 
Hi there, I don't have the links handy but that payer is phasing in new incident to rules that include requiring SA whenever the billing provider reports incident-to services. If the NPs are enrolled and bill directly you won't need it for their claims.

BCBSMI has a notice about it on their website and sent a detailed FAQ to contracted providers.
 
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They are allowing incident-to billing through to 03/01/27 (phase 2 start date), but you have to append the "SA" mod to these claims from 09/01/26 - 03/01/26. As of 03/01/27, any provider type eligible for direct billing must do so
 
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