Wiki Workers Compensation

[rakeley]

What is the correct way to bill PA’s and NP’s for E&M codes and Level 1 CPT codes for Workers Compensation in Masshachusetts? When billing PA’s, do we bill them as the rendering provider and have their NPI and Taxonomy code in field 24J on HCFA1500 and use modifier SA ? Will work comp accept modifier SA as the HN modifier was dropped from the States Physician Manual and I cannot find any other modifier that would be appropriate. When billing NP’s do we bill them the same way as the PA?

 

[ambernic]

What is the correct way to bill PA’s and NP’s for E&M codes and Level 1 CPT codes for Workers Compensation in Masshachusetts? When billing PA’s, do we bill them as the rendering provider and have their NPI and Taxonomy code in field 24J on HCFA1500 and use modifier SA ? Will work comp accept modifier SA as the HN modifier was dropped from the States Physician Manual and I cannot find any other modifier that would be appropriate. When billing NP’s do we bill them the same way as the PA?

Hi,

I actually work for a payor that reviews workers' compensation claims. Massachusetts is one of the states we review. We accept the PA/NP being billed as the rendering provider using their NPI in 24J. However, if the physician is billed as the rendering provider but the PA/NP signs the report without the MD signing as well, we require the SA modifier.