The SA modifier arrives September 1.
A billing-code change small enough to miss and expensive enough to matter. It applies to Blue Cross commercial and BCN commercial claims; Medicare Plus Blue and BCN Advantage are excluded.
For dates of service on or after September 1, 2026, professional incident-to claims require modifier SA. Limited-licensed clinicians append HO or AJ as well. Provider types never eligible for incident-to billing do not use SA: behavior technicians in ABA, community health workers and peer supporters, dieticians, occupational and physical therapy assistants, and RNs. Claims continue to pay at the submitting provider’s rate through February 28, 2027. Value-based reimbursement ends for all incident-to claims on September 1.
Facing the February deadline too? Do I need to join a facility by February 28?
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