Wiki SA modifier help

[drampas3418]

i know i need to attach the SA modifier to e/m codes however my physican assistants perform biopsies and surgeries in our office. they are not contracted under digna insurance . in the past we have billed under the md per cigna instructions however eff 2/1/22 we can no longer do that. so the e/m codes ill bill with mod sa but how do i bill the surgical codes? any thoughts here?

 

[thomas7331]

The official definition of modifier SA is "Nurse practitioner rendering service in collaboration with a physician" so was not originally intended to be used for a PA or exclusively for E/M services, but I do know that some payers have their own guidelines for its use in other situations. If I was going to use it for situations outside of the definition I'd want to be sure I was aligning to the specific payer's policies so there's no misunderstanding.

I wasn't aware that Cigna was changing is practice for PA services this year, so I can't advise on how they wish you to bill those claims going forward, but I wouldn't just make the assumption that this is the modifier they want you to use unless they've published it in writing.