Ophthalmology and Optometry Coding Alert

Question: Our ophthalmology practice employs a nurse practitioner (NP), and when she provides supervised services, should we append modifier SA? Our insurer just denied a claim because we didn’t include it and we’ve never heard of it.

Answer: 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 require this modifier. Some Medicaid programs require you to apply modifier SA to all Nurse Practitioner (NP) services which are submitted under the physician provider number.

Example: A nurse practitioner provides a level three established patient office visit to a Medicaid patient. The ophthalmologist supervises the service. To indicate the NP provided the office visit under direct supervision, you would append modifier SA to 99213.

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