CurrentPremera BluecrossPolicy cmi_057519

Modifier SU - Procedure Performed in Physician's Office (Facility and Equipment)

Defines when Premera recognizes and reimburses services appended with modifier SU on professional claims and who this applies to (Premera Blue Cross lines of business and affiliates).

Policy Summary

PayerPremera Bluecross

PolicyModifier SU - Procedure Performed in Physician's Office (Facility and Equipment)

Policy CodePolicy cmi_057519

Change TypeClarification updates

Effective Date

Next Review Date

Key ActionDo not append modifier SU to any procedure billed with place of service 11 (office setting).

SourceLink

POLICY UPDATE CHANGES

Clarified the policy statement to include examples of facility services and details to indicate modifier SU is not allowed with POS 11.

Clarified the Purpose statement to indicate that the policy pertains to Professional services billed on a CMS-1500 or 837P claim forms.

Added third paragraph clarifying inclusion of office facilities and equipment in practice expense and that they are not separately reimbursable.

05/12/26most recent annual review date

5 linesApplies to

cmi_057519document identifier

Coverage Criteria

Modifier SU coverage criteria

Covered with criteria and restrictions as follows:

The Plan recognizes modifier SU when appended to a professional service to indicate use of facility and equipment (e.g., supplies, staff, costs associated with running an office).

Use of office facilities and equipment are considered included in the practice expense RVUs for services or procedures performed in the office setting and are not separately reimbursable.

Modifier SU should not be applied to any procedure code billed with Place of Service = 11 (Office setting).

Exceptions may be made where a provider or employer group contract dictates otherwise.

Enforcement:

Policy Summary

PayerPremera Bluecross

PolicyModifier SU - Procedure Performed in Physician's Office (Facility and Equipment)

Policy CodePolicy cmi_057519

Change TypeClarification updates

Effective Date

Next Review Date

Key ActionDo not append modifier SU to any procedure billed with place of service 11 (office setting).

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.

Violations of this policy by any party that enters into a written arrangement with the Plan may result in increased auditing and monitoring, performance guarantee contractual penalties, and/or termination of the contract; disciplinary actions will be determined by the plan.

Coding and Place of Service

Modifier SU usageModifierNot Covered

No codes listed

Place of Service restriction

RestrictionModifier SU must not be applied when Place of Service = 11 (Office).

RationaleOffice facilities and equipment are considered included in the practice expense of relative value units for services/procedures performed in the office and are not separately reimbursable.

Billing consequenceThe Plan does not reimburse any procedure code billed with modifier SU when billed with POS 11.

EnforcementViolations may result in increased auditing, contractual penalties, and/or contract termination; disciplinary actions determined by the plan.

Provider Billing Rules and Actions

Billing Rule

Do not append modifier SU to procedures billed with POS 11

Do not append modifier SU to any procedure billed with place of service 11 (office setting). Modifier SU indicates use of facility and equipment and is not separately reimbursable when practice expense already includes office facility/equipment.

Modifier SU denotes a procedure performed in a physician's office to reflect additional cost for use of facility and equipment (e.g., supplies, staff, costs associated with running an office).
The Plan does not reimburse any procedure code billed with modifier SU when billed with place of service 11; exceptions may apply only if a provider or employer group contract dictates otherwise.

Definitions

Modifier SU — Procedure performed in physician's office

DefinitionModifier SU — Procedure performed in physician's office (to denote use of facility and equipment).

Intended useAppended to a professional service to indicate additional cost for use of office facility and equipment (e.g., supplies, staff, office operating costs).

Plan positionThe Plan recognizes SU when appended to a professional service but considers office facility/equipment included in practice expense RVUs and does not separately reimburse those costs.

ExceptionsExceptions may be made where a provider or employer group contract dictates otherwise.