Author Topic: Both CMS 1500 and UB04 forms, CPT4 with modifier SG - is this right?  (Read 1698 times)

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4770
    • Solutions Medical Billing
Question
Hi,
Some of the insurance companies have been accepting claims printed on CMS1500 for our ambulatory care facility, and some want us to use the UB92/UB04. We were advised to use the CPT4 code for the surgery performed with the modifier SG. Could you tell me if this is the best approach, and what SG stands for?
Thank you very much,
Nancy O.

Answer
Hi Nancy,
The SG modifier indicates Ambulatory Surgical Center (ASC) facility service so it is the correct modifier to use with the cpt code for the surgery.
Hope that is helpful,
Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Tracy

  • Newbie
  • *
  • Posts: 8
Re: Both CMS 1500 and UB04 forms, CPT4 with modifier SG - is this right?
« Reply #1 on: June 09, 2008, 03:11:21 PM »
I'm curious as to what insurance companies are asking you to bill on UB92/UB04?  I have never billed any insurance company on UB92/UB04 form, nor have I been ask by an insurance company to do so. If you have been billing Insurance companies without a SG modifer in the past your reimbursement rates would  have been lowered. Medicare is no longer requireing the SG modifier when billing for an ASC but all of my other insurance companies are.