In the March issue of Insights and Updates for Providers we offered some reminders of correct coding practices to keep in mind during certain billing scenarios, including when billing for ambulatory surgical center services.
We’re providing another reminder to support our providers in ensuring that you’re billing appropriately for these services, and to offer some additional clarification. When billing for ambulatory surgical center facility services on a CMS-1500 form or an 837 professional claim transaction, remember to include the modifier SG in order to apply the correct benefit configuration (e.g., cost sharing, deductible).
Please keep in mind that this modifier is applicable only to claims from ambulatory surgical centers for facility charges; it is not billable on claims for physician or other qualified health care professional services. Modifier SG is intended for use as an informational modifier to be appended to any facility service rendered by an ambulatory surgical center to identify it as an ambulatory surgical center service.
When applicable, always submit a modifier that reduces the fee schedule/allowable amount in the primary modifier position, and modifier SG in the secondary position.