MedicaidReimbursementMedium impact
Increased Payment for Primary Care Services Provided by Advanced Practice Nurses
Illinois Medicaid - HFS·IL · Family Medicine, General Practice, Internal Medicine·Provider Notice
Effective date
Jul 29, 2013
We identified it
Jun 20, 2026
Summary
Advanced Practice Nurses (APNs) working under physician supervision are now eligible for increased primary care payment rates under the Affordable Care Act. All APN services must be billed under the supervising physician's NPI with modifier SA to receive the higher reimbursement rates.
Action Required
Immediately: Update billing procedures for APN services - bill all APN primary care services under supervising physician's NPI as rendering provider and add HCPCS modifier SA to each service line. For electronic claims (837P), enter physician NPI in Loop 2310B. For paper claims (HFS 2360), enter physician NPI in field 30 and name in field 31. For Medicare crossover paper claims (HFS 3797), enter physician NPI in field 23 and name in field 22. Failure to follow these billing instructions will result in standard payment rates instead of increased ACA rates.