tci E/M Coding Alert - 2017 Issue 12

Modifiers: UHC Now Mandates Appending Modifier SA on NPP E/M Claims

Not all payers follow this particular policy, so double-check with your individual payers. Do you bill non-physician practitioners' (NPPs) evaluation and management (E/M) services to UnitedHealthcare (UHC)? If so, make sure you didn't miss their new policy, which now requires you to append modifier SA (Nurse practitioner rendering service in collaboration with a physician) on physician-submitted claims involving NPPs. This policy went into effect for claims with dates of service on or after September 1, 2017, according to the Network Bulletin UHC released this summer. "UnitedHealthcare will require physicians reporting E/M services on behalf of their employed Advanced Practice...

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