SA modifier

Millport, AL
Best answers
Can someone please give me some guidance on this modifier? I received a letter from Cigna stating that we would need to start appending this modifier to our claims for patient's seen by our NP. Our NP only see's patient's on rounds in the hospital, she does not see patient's in the clinic. Would we still append modifier SA if we bill under the physician for the patient's she sees? Our physician signs off on her notes after doing a brief visit with each patient at the end of each day.

Thanks in advance!!


True Blue
Best answers
For inpatient visits, you should review the new split/shared guidelines and new modifier -FT may be more appropriate. If your NP is doing a full history/exam/workup on a patient and then the MD really just signs off and notes "Saw pt & agree with NP plan", you can't bill under the MD. For 2021, you can decide whether the history, or exam or MDM is the "substantive" portion of the visit and bill based on the MD level for the substantive portion along with the NP work. In 2022, the plan is for bill is submitted only under whichever provider spent more time.
Modifier -SA is one of those modifiers that each carrier wants used slightly differently. Some want for any E/M service. Some want only for incident-to. Medicare does not even recognize/accept it.