SA Modifier and Midlevel Provider Contracting Update

May 12, 2021

Updated May 25, 2021

Note: Refer to the SA Modifier Clarification below

On Jan. 19, 2021, Blue Cross and Blue Shield of Texas (BCBSTX) posted an article regarding contracting and credentialing midlevel providers and the upcoming implementation of the ClaimsXtenTM edit of the SA modifier for non-payable services resulting in the SA modifier being non-reimbursable. This edit has not been implemented and there are currently no plans for future implementation of this edit.

SA Modifier Clarification

  • Append modifier to supervising physician claim when billing on behalf of a Physician Assistant (PA), Advanced Practice Nurse (APN), or Certified Registered Nurse First Assistant (CRNFA) for non-surgical services
  • Append modifier to PA’s, APN’s, or CRNFA’s claim when billing with their own NPI number for assisting with any other non-surgical procedures.
  • Claims will be processed based on the provider’s contracting status.

This information can be found in the Clinical Payment and Coding PoliciesModifier Reference Guideline located on the provider website. Information about the reimbursement amount for the SA modifier is available in the Reimbursement Schedules and Related Information (Secure Content) area of the General Reimbursement information page. You will need a password to access this information which can be obtained from your local Network Management Office location.

Contracting and Credentialing Midlevel Providers

BCBSTX directly contracts and credentials with midlevel providers. Refer to the Network Participation page on the provider website for the process to directly contract and credential these providers. We appreciate your consideration to become a directly contracted provider.

Please contact your Network Management Office if you have further questions.