Aetna walks back payment change for modifiers SA and SB

Health insurer Aetna has reversed a payment change it announced in January regarding modifiers for services provided by nurses with certain special certifications. Aetna had previously said that starting April 1, it would pay for services billed with modifiers SA (nurse practitioner) and SB (nurse midwife) at 85 percent of the allowed amount for both its commercially insured and Medicare Advantage members.

But in a Feb. 10 update, Aetna clarified that they will not proceed with this change, and therefore its payment rates for services billed with modifiers SA or SB will stay the same.

The update notes that for Texas providers the changes described will be implemented for fully insured plans written in the state of Texas only if they align with applicable regulatory requirements.

— Brennan Cantrell, AAFP Senior Strategist, Market Transformation