CurrentBlue KCPolicy POL-PP-250

Modifier SU — Reimbursement Policy

Defines Blue KC's reimbursement stance for services appended with HCPCS modifier SU and explains applicability to participating and nonparticipating professional and facility providers across affected lines of business.

Policy Summary

PayerBlue KC

PolicyModifier SU — Reimbursement Policy

Policy CodePolicy POL-PP-250

Change TypeAnnual review — no material changes

Effective DateOct 1, 2025

Next Review DateOct 1, 2026

Key ActionDo not bill for separate reimbursement when services are appended with modifier SU; costs are included in practice expense RVUs.

SourceLink

POLICY UPDATE CHANGES

Annual review on 10/01/2025 noted no changes or updates were made to this policy.

POL-PP-250identifier

10/01/2025version effective date

Professional & Facilityprovider impact

No separate reimbursementcoverage stance

08/13/2024creation date

Modifier SU Coverage Criteria

Modifier SU coverage criteria

Reimbursement policy for services appended with modifier SU:

Blue KC shall not reimburse separately for services appended with modifier SU; costs are considered included in practice expense RVUs.

Modifier SU denotes the use of facility and equipment for a procedure performed in a physician's office.

Relative Value Units (RVUs) for CPT and HCPCS codes include practice expense costs (rent, equipment, supplies, nonphysician staff), which are not reimbursed separately when Modifier SU is appended.

Policy applies to participating and nonparticipating professional providers and affects professional and facility billing; coverage remains subject to member eligibility, benefit limits, provider agreements, coding rules, and claims adjudication edits.

HCPCS Modifier and Codes

Policy Summary

PayerBlue KC

PolicyModifier SU — Reimbursement Policy

Policy CodePolicy POL-PP-250

Change TypeAnnual review — no material changes

Effective DateOct 1, 2025

Next Review DateOct 1, 2026

Key ActionDo not bill for separate reimbursement when services are appended with modifier SU; costs are included in practice expense RVUs.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Prior Authorization and Reimbursement Actions

Billing Rule

No separate reimbursement for services with modifier SU

Blue KC will not provide separate reimbursement for services appended with HCPCS modifier SU because the practice expense RVUs for CPT/HCPCS codes already include office running costs (rent, equipment, supplies, nonphysician staff). Providers should bill the service with modifier SU as appropriate but understand that no additional separate payment will be made for that modifier.

Modifier SU denotes use of facility and equipment for a procedure performed in a physician’s office.
Practice expense RVUs include costs of running an office; therefore separate reimbursement for SU-appended services is not allowed.

Key Definitions

Modifier SU — Definition

DefinitionModifier SU is a Health Care Common Procedure Coding System (HCPCS) modifier used to denote a procedure performed in a physician's office (to denote use of facility and equipment).

Coding systemHCPCS

PurposeIndicates use of the facility and equipment when a procedure is performed in a physician's office.

ApplicabilityApplies to participating and nonparticipating professional providers; used to document office-based procedures.

Practice expense RVU — Explanation

Practice expense RVU — definitionRelative Value Units (RVU) for CPT and HCPCS codes include the costs of running an office (such as rent, equipment, supplies, and nonphysician staff costs), referred to as the practice expense RVU.

Inclusion of office costsPractice expense RVUs reflect overhead and equipment costs associated with performing services in a physician's office.

Reimbursement effectBecause practice expense RVUs include office running costs, Blue KC shall not reimburse separately for services appended with modifier SU.

CMS alignmentPolicy is consistent with the approach taken by CMS regarding inclusion of practice expenses in RVUs.