Modifier SG Ambulatory Surgery Center (ASC) facility services and Place of Service 24
Defines when Premera recognizes ASC facility services billed on CMS-1500 (paper) or 837P (electronic) claims, including use of Modifier SG, Place of Service code 24, and entry of the ASC NPI; applies to multiple Premera and LifeWise lines of business.
Added clarification on what data elements should be submitted to identify ASC facility services.
Clarified the correct use of the Place of Service code 24 and the Modifier SG.
Added instructions for entering the ASC's NPI on CMS-1500 and 837P claims and guidance not to populate alternate NPI fields if ASC NPI cannot be entered.
ASC Claim Recognition and Submission Criteria
ASC claim submission criteria
Recognition and submission criteria for ASC facility services on CMS-1500 and 837P claims:
ALL of the following
- On the CMS-1500 paper claim form: enter the ASC's NPI in field 24J.
- On the 837P electronic claim: enter the ASC's NPI in 2310B or 2420A NM109.
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