Wiki Is modifier SA required?

[ollielooya]

SA = Nurse practitioner rendering service in collaboration with a physician.

This modifier is used when the incident to services are provided, and the claims are billed out with the doctor's NPI, correct? If the SA is not attached, will this affect reimbursement, or flag a claim? Irregardless of outcome, would a corrected claim be required?

 

[jmconnor]

We use the SA modifier when the NPP sees the patient but the insurance does not credential the NPP. It notifies the insurance company that the NPP was actually the one who saw the patient but we had to bill under the MD in order to get the claim to go through.

Incident to only applies to Medicare and they do not recognize the SA modifier.

It is so confusing; we are dealing with issues right now about it.