SA Modifier – Are you using it?
Image Credit: HCMS
What is the -SA modifier?
The -SA (HCPCS) modifier identifies services rendered by an NP (Nurse Practitioner). Some payers use the modifier to indicate that a non-surgical service was provided by an advance practice provider.
When do I use it?
An -SA modifier is used when the rendering provider, typically a nurse practitioner, performs a service that is reported as incident-to a physician service.
Who requires it?
Most of the big payers require it, except Humana and Medicare. Aetna, BCBS, Cigna, and United all require an -SA on their incident-to claims. Medicaid requires the -SA for a nurse practitioner, and a –U7 for a physician’s assistant regardless of billing type in many states.
Why do I need to know this?
If you are utilizing advance practice providers in the care of your patients, you need to know how to appropriately report services for them. The OIG is reviewing incident-to claims with a report coming out in 2026. BCBS Anthem essentially stopped paying for incident-to services the summer of 2024. Aetna came out with a policy stating they plan to follow suit with an effective date of April 1, 2025. Will incident-to become a thing of the past? Maybe. No one seems to understand the requirements. Without the modifier, it is almost impossible to identify by running a simple report. The three most common ways to discover incident-to services are (1) the impossible day (2) self-disclosure, or worst of all, (3) a whistle blower.
Harris County Medical Society Page
The HCMS has maintained an incident-to grid for many years. The grid identifies how Texas payers process direct billing or incident-to billing when advance practice providers are involved. There are other types of non-physician providers that also report services incident-to. Listed below are some of the most common modifiers used to identify the many types of providers. This is not an all-inclusive list.
Non-Physician Modifiers
- SA – nurse practitioner
- SB – nurse midwife
- U7 – physician assistant
Non-Physician (Mental Health) Modifiers
- AH – clinical psychologist
- AJ – clinical social worker
It will be interesting to see how the billing concept known as incident to evolves. Clearly, for now, it isn’t going away. But it sure looks like they are eliminating it without eliminating it by taking away the incentive to report advance practice provider services in this way. Stay tuned. In the meantime, check out some of our other incident-to articles listed below.
Resources
MSHBC Incident to – Still on the OIG Radar
MSHBC Incident to – Billing Basics
HCMS Incident to Billing Guide