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Elizabeth M. Whitehorn, Director

Provider Notice issued 07/29/13

prn130304a.aspxIncreased Payment for Primary Care Services Provided by Advanced Practice Nurses

To:​ Enrolled Physicians and Advanced Practice Nurses ​
Date:​ July 29, 2013​
Re:​ Increased Payment for Primary Care Services Provided by Advanced Practice Nurses ​

The purpose of this notice is to inform providers of the department’s policy regarding services provided by Advanced Practice Nurses (APNs) and the Affordable Care Act (ACA) increased payments for certain primary care services. The March 4, 2013 Informational Notice, Increased Payment for Primary Care Services (pdf), outlined the eligibility requirements for physicians.

Services performed by APNs under the personal supervision of an eligible physician who assumes professional responsibility (and legal liability) for those services will be reimbursed at the increased rate for primary care services. Such services must be submitted under the National Provider Identifier (NPI) of the eligible, supervising physician as the rendering provider.

Billing instructions for these services are as follows:

Services Billed Electronically: 837P

  • Loop 2310B, Rendering Provider must contain the NPI of the supervising, professionally responsible physician.

  • HCPCS Modifier “SA”, “Nurse practitioner rendering service in collaboration with a physician” must be entered into the modifier field for each service line.

Services Billed on a Paper Claim: (HFS 2360)

  • The individual NPI of the supervising, professionally responsible physician must be entered in field 30, and the corresponding physician name must be entered in field 31.

  • HCPCS Modifier “SA”, “Nurse practitioner rendering service in collaboration with a physician” must be entered into the modifier field for each procedure code.

Medicare Crossover Services Billed on a Paper Claim (HFS 3797)

  • The individual NPI of the supervising, professionally responsible physician must be entered in field 23, and the corresponding physician name must be entered in field 22.

  • HCPCS Modifier “SA”, “Nurse practitioner rendering service in collaboration with a physician” must be entered into the modifier field 12 for each procedure code

Any questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565, option 3, and then option 1.

Theresa A. Eagleson, Administrator

Division of Medical Programs