Wiki Independent Nurse Practitioner modifier?

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sjooemmy08

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Hello friends,

Do you know what modifier could possibly be used for independent NP?
I know AS is for non-physician providers assisting surgery, but we're an FQHC and our NP does not participate in surgeries.
She is seeing patients for general practice.

I tried calling CalOptima, which is a managed Medicaid, but they put me on hold for +1hr and hung up eventually...
Help me out here!
 
A few payers require modifier SA be added to identify services provided by nurse practitioners, but in my experience most payers do not need a special modifier because the provider is already identified by the NPI on the claim - if that's the case you would just bill the same as you would for a physician. If you can't get through to them on the phone, you might be able to find some direction by reviewing their provider manual on line, if they have one.
 
thomas7331 said:
A few payers require modifier SA be added to identify services provided by nurse practitioners, but in my experience most payers do not need a special modifier because the provider is already identified by the NPI on the claim - if that's the case you would just bill the same as you would for a physician. If you can't get through to them on the phone, you might be able to find some direction by reviewing their provider manual on line, if they have one.
Click to expand...
I already submitted the claim and they denied it for the reason of not having a valid modifier.

There was a similar case with our clinical social worker, where we needed to put a modifier to indicate that she is contracted LCSW with CalOptima.
It didn't make sense to me at first (and even now too) because they could figure it out with the NPI numbers, but I just went ahead and put the requested modifier so that I could get the payment from them. It took me a few hours to figure that out on the phone that day...

Thank you for your help though!
 
sjooemmy08 said:
I figured it out myself! it's AS for PAs and NPs
Click to expand...
No, definitely not. Modifier -AS is for physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery.
You indicated in your original post that the NP does NOT assist at surgery.
The advice from @thomas7331, which I do agree with is that if the claim is billed under the NP, nothing should be needed. If the claim meets the requirements and is being billed incident to, then some carriers want modifier -SA.
I will note that some carriers like to make their own rules up. But I have never heard of nor seen -AS used unless the NPP is assisting at surgery.
 
csperoni said:
No, definitely not. Modifier -AS is for physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery.
You indicated in your original post that the NP does NOT assist at surgery.
The advice from @thomas7331, which I do agree with is that if the claim is billed under the NP, nothing should be needed. If the claim meets the requirements and is being billed incident to, then some carriers want modifier -SA.
I will note that some carriers like to make their own rules up. But I have never heard of nor seen -AS used unless the NPP is assisting at surgery.
Click to expand...
Oh, I did not read the definition of AS all the way through haha. I only read the part where it says PA or NP. Thank goodness I did not submit the claims yet.
Thank you for letting me know!
 
I bill for Pa and NP and do not use a modifier as the NPI number let’s them know there clinical level. I cannot bill these providers to our state Medicaid and a couple carriers as they donot pay these clinicians
 
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