Question SG Modifier

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Can anyone clarify for me exactly what the SG modifier is still used for? All specific circumstances would be greatly appreciated. Would a non-standard bill for a facility fee where the CPT code is used as the facility fee billed 64479-SG an acceptable AAPC billing code? We have seen a lot of non-standard billing with pain management where the facility fee is is billed with the CPT code from a ASC that is connected with the surgeon. Is a 64479-SG an acceptable billing - exclusive of the UB04 or CMS1500 forms? They are not using these forms of billing. Also, does anyone have any idea why they prefer to bill their facility fees this way? Thank you!
 

thomas7331

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Modifier SG is normally used to distinguish facility charges when billed on a HCFA/CMS-1500 form from professional charges. It has fallen into disuse because with the implementation of NPI numbers and through changes in payer credentialing processes, it is possible for most payers to identify from the provider numbers on the claims form whether the billing and/or rendering provider is a facility or a physician, which makes the modifier redundant in most payer systems. As far as I know, you would only need to use this modifier if you are billing a facility fee on a CMS-1500 and the payer to whom you are billing has instructed you to submit the claims this way with the modifier.
 
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Location
Lincoln, NE
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Thank you very much! Our problem is that a few pain management providers are submitting bills to us on non-standard billing forms and being a liability carrier, in some instances, we are not able to request billing on the appropriate forms (UB04 or CMS-1500). So we are looking at claims for which the facility fee, being billed exactly the same as the surgeon fee is kicked out as a duplicate. We legally cannot request billings to fit our payor system because we are not a health care provider. In this case, for those pain management providers that choose to use non-standard billing, would the following be an acceptable AAPC coding principle: Surgeon billed as 64479, and, associated facility fee 64479-SG? Even though not submitted on the CMS-1500? Thank you so much for your response!
 
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