# SA modifier vs AS modifier



## tmarugg (Aug 18, 2016)

*AS modifier out of network payer*

I work in a neurosurgery office in Texas.  We have 2 mid-levels who are employees of the surgeons & assist in surgeries as well as seen patients in the office.  

Some of our contracts are with an IPA that does not credential mid-levels.  Because we are a delegated group, we cannot go outside the IPA to contract with the few insurances that we have with them to get in-network status for our mid-levels.

I am being told (by the IPA) that when billing for mid-level surgical services to out of network payers, we should append the AS modifier to the charges with the rendering provider NPI being that of the surgeon, because the mid-level would not be in the payers system.

For our in-network surgical claims, we use the AS modifier & the mid-level rendering NPI.

Can someone please give me clarification on this?  Any additional documentation you could provide, would be greatly appreciated!!!

Thanks in advance!

Tammy


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## catharine (Aug 24, 2016)

*- AS Modifer*

According to Medicare whenever a surgical assistant services are provided by a PA, NP or CNS, we are to use the-AS modifier in place of the -80.   The SA modifier is used by Medi-Cal or Medicaid.  So for any insurance that followes Medicare/private insurance use the -AS modifier.  If they follow Medicaid/Medi-cal guidelines use the - SA.

Hope that helps


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