Monday, May 2, 2011

HCPCS - Don't Use Modifier SA for Medicare Patients

You should use HCPCS Level II Modifier SA for Supervised Nurse Practitioner Services when the Insurer does need Modifier SA.

The Nurse Practitioner (NP) provides unsupervised services. Following this, I bill the codes under the nurse practitioner's number for supervised visits, I use modifier SA. In such a scenario, would I bill using the rendering or the supervising provider's NPI? Will payers reduce payment for a supervised visit?

Well, you should use HCPCS Level II modifier SA (Nurse practitioner rendering service in collaboration with a physician) for supervised nurse practitioner services when the insurer does need 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 physician provider number. You should not use this modifier for Medicare patients as this modifier is not covered or valid for Medicare and therefore payments may be denied.

Here's an example to help you in your understanding: A nurse practitioner provides a level three established patient office visit to a Medi-Cal patient. The nurse practitioner's urologist supervises the service. To show the nurse practitioner provided the office visit under direct supervision, you would add modifier SA to 99213.

For incident-to services that are billed under the supervising physician's NPI number go for modifier SA. The modifier tells the insurer that the nurse practitioner rather than the physician provided the service and the physician supervised the nurse practitioner. Incident-to services are paid at 100 percent of the Medicare Physician Fee Schedule amount.

Insurers may apply a reduction to services billed directly under the nurse practitioner's NPI. Normal reduction here is 15 to 20 percent.

So you haven't heard of modifier SA is it? Well, HCPCS Level II created the HIPAA compliant modifier to standardize Nurse Practitioner reporting. For instance, before February 2009, Medi-Cal previously used modifier YT (Nurse practitioner service [multiple modifiers]).

For further details, sign up for a one-stop medical coding guide like Supercoder .