Provider Digest | Issue 12

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Modifiers for non-physician medical practitioners

Non-physician medical practitioners include physician assistants (PA) and nurse practitioners (NP). Each PA and NP seeing patients requires the supervision of a physician.

When billing for patient visits with PAs or NPs:

  • Make sure to affix the appropriate modifier to the CPT or HCPCS codes.
  • Use the supervising physician’s provider number on each claim line and as the rendering provider.
  • Include the PA or NP name and provider number in the claim’s remarks.

Non-physician medical provider type

  • Physician assistant (PA): Modifier U7.
  • Nurse practitioner (NP): Modifier SA.

Remarks field

  • CMS1500 Box 19.
  • UB-04 Box 80.

Supervising physician and Adverse Childhood Experiences (ACE) screenings

Physician assistants (PA) and nurse practitioners (NP) should bill ACE screenings under the supervising physician. The supervising physician should be a Medi-Cal provider who has taken the ACE training, provided an attestation and assumes responsibility for the screening and results. We encourage all providers who conduct ACE screenings to complete the necessary training and attestation.

For details on ACE screening and attestation, please refer to the ACEs article published to our website.

The Alliance receives co-partnering PRACTICE grants to improve ACE screening in communities

The Alliance is pleased to be selected as a partnering organization to receive a Preventing and Responding to Adverse Childhood Experiences (ACE)-Associated Health Conditions and Toxic Stress in Clinics through Community Engagement (PRACTICE) award through the ACEs Aware initiative.

We will be partnering with organizations in Merced and Santa Cruz counties to increase the workforce and services needed for primary care clinics to expand and sustain screening and response to Adverse Childhood Experiences (ACEs).

In Merced County, the lead organization is Valley Children’s Olivewood Pediatrics with an award of $500,000. We will be working with Valley Children’s Primary Care (Olivewood Pediatrics), ACE Overcomers, ACEsINC, First 5 Merced County and Unite Us.

In Santa Cruz County, the lead organization is Safety Net Clinic Coalition with an award of approximately $1 million. We will partner with United Way of Santa Cruz County, Salud Para La Gente, Santa Cruz Health Services Agency, Santa Cruz Community Health Centers, Doctors on Duty and Santa Cruz Health Information Organization.

Teams will identify gaps in their communities in care and services and, through a statewide learning collaborative, leverage existing and new sources of state funding to build sustainable capacity to fill these gaps.

This PRACTICE grant will help provide opportunities for the Alliance to partner with providers and community-based organizations to promote ACE screenings and trauma-informed care. We look forward to collaborating in pursuit of our strategic priority of health equity and our goal to eliminate health disparities and achieve optimal health outcomes for children and youth.

For more information and a full list of awardees, visit the links below.