ASC modifier - SG

Ambulatory Surgery Centers modifier - SG

Every ASC must file using the surgery code with the SG modifier. This identifies you are filing for the facility fee. If you file without the SG modi fier you may receive the fee schedule amount for the surgery instead of the payment from the group rate for the facility fee This is sometimes much lower than the facility fee and it will cause the surgeon ’ s claim to deny. You would have to file a first line appeal to have the SG modifier added and receive any additional payment due to you. You will only be paid for services that the Centers for Medicare and Medicaid (CMS) approved as an ASC service. These updates are published yearly as they are received from CMS. Code 69635SG allows $957.36 (Richland and Lexington Counties), but when filed without the SG (69635) it allows $826.74.


Please refer your local Medicare program since it was deleted modifier in some states.