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Modifier Clarification

Annmarie Posted Mon 21st of March, 2011 16:12:31 PM

Please clarify as I had been advised a couple weeks ago on this site to append a "SA" modifier for "incident to" NP billing to the OV code 99214 for medicare. Just received denial from medicare " procedure code is inconsistent with the modifier used. HELP!!

SuperCoder Answered Tue 22nd of March, 2011 06:26:06 AM

Exactly right. 99214 cannot be billed with SA modifier. You could see when you will type 99214 and will go to modifier crosswalk. There is no any SA modifier for 99214.

The patient’s chart should indicate that the physician was in the office when the services were provided. If no physician is present, you may not bill services as incident to. That means that if an NPP other than an NP, a, PA or a CNS performed the service, it may not be billed.

Incident-to services are billed just as if the physician did the service himself. The back of the HCFA 1500 clearly indicates the claim can either designate services provided by the physician or services provided under his supervision.

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