tci Medicare Compliance & Reimbursement - 2013 Issue 21

Reader Question: Check With Payer Before Adding SA

Question: When the NP provides unsupervised services, I bill the codes under the nurse practitioner’s number for supervised visits, I use modifier SA. Would I bill using the rendering or the supervising provider’s NPI? Will payers reduce payment since this is not a supervised visit? Answer: You should use HCPCS Level II modifier SA (Nurse practitioner rendering service in collaboration witha physician) for supervised nurse practitioner services when the insurer does require this modifier. Some Medicaid programs such as Medi-Cal require you to apply modifier SA to all nurse practitioner (NP) services which are submitted under the...

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