Wiki Modifier SA

[rnewsome]

Is this modifier valid for Medicare claims? We are not having issues with any other insurance paying including the Medicare Advantage ones, just Medicare. We have not billed incident to before and was instructed that this modifier is to be used to show that the provider is billing on behalf of the PA.

Would appreciate any help.

 

[mhstrauss]

Is this modifier valid for Medicare claims? We are not having issues with any other insurance paying including the Medicare Advantage ones, just Medicare. We have not billed incident to before and was instructed that this modifier is to be used to show that the provider is billing on behalf of the PA.

Would appreciate any help.

I've never read anywhere that Medicare requires SA to be used on Incident-to Claims. Have you checked your MAC's website specifically? My MAC (Novitas) has stated that there does not need to be any indication on the claim itself that the charge is being billed incident-to, but in the event of an audit, we have to prove that the requirements are met...supervising physician was in the office, remained active in the care of the patient, PA following the MD's treatment plan, etc.

 

[Kisalyn]

I'm with mhstrauss. I've never heard Medicare wanting an SA modifier. I know for NGS, WPS and CGS, I've never submitted it on incident-to claims.

The only payor we use it for is Cigna.