Wiki Nurse Practitioner Billing - We have a nurse practitioner

[m*larusch]

We have a nurse practitioner that we are billing E/M services for and we recently had to send her first claim to Medicaid. They denied stating the appropriate modifier was missing. We contacted Medicaid and they stated we needed to bill with modifier SA. When I looked up the definition it states "Nurse Practitioner rendering service in collaboration with a physician". In this case she was, so we will add the modifier, but my question is does anyone know would we use this modifier if she sees a patient on her own with no physician supervision? Medicaid states we are supposed to use this modifier whenever we bill for our NP. The description is throwing me off though because it says "in collaboration with a physician". Any information would be greatly appreciated!

 

[mitchellde]

All NPs practice under a collaborative agreement with a provider. It is a legal document. The physician does not have to physically be present but must be witching the boundaries stipulated in you state laws available if needed by fax phone pager.

 

[VanettaP]

Thank you very much. This was a great help.

 

[coloradopa]

All NPs practice under a collaborative agreement with a provider. It is a legal document. The physician does not have to physically be present but must be witching the boundaries stipulated in you state laws available if needed by fax phone pager.

That's not quite correct. In some states, NPs are independent providers and do not practice in collaboration with physicians. On the other hand Medicaid can require collaboration even if the state doesn't