Effective for dates of service on or after February 1, 2009, local Non-physician Medical Practitioner (NMP) modifiers AN, YU, YR and YT will be replaced with national HCPCS and CPT-4 modifiers to comply with HIPAA. The updates are as follows:

Previous Modifier	Previous Modifier Description	National Modifier	National Modifier Description	Billing Instructions
AN	Physician Assistant service	U7	Medicaid Level of Care 7, as defined by each state	NPI of the supervising physician must be entered in the rendering physician section and the NMP name, NPI and type of NMP must be entered in theReserved for Local Use field (Box 19) of the appropriate claim form.
YU	Physician Assistant service (multiple modifiers)	99 U7	Multiple Modifiers Medicaid Level of Care, as defined by each state (listed in the Reserved for Local Use field)	Enter the applicable procedure code with modifier 99 in the Procedures, Services, or Supplies field (Box 24D). In theReserved for Local Use field (Box 19) enter “99 = Modifier U7 + [additional modifiers as appropriate].”
YR	Certified Nurse Midwife service (multiple modifiers) (when billed by a physician, organized outpatient clinic or hospital outpatient department)	99 SA	Multiple Modifiers Nurse midwife (listed in Reserved for Local Use field)	Enter the applicable procedure code with modifier 99 in the Procedures, Services, or Supplies field (Box 24D). In the Reserved for Local Use field (Box 19) enter “99 = SB + [additional modifiers as appropriate].”
YT	Nurse Practitioner service (multiple modifiers)	99 SA	Multiple Modifiers Nurse Practitioner rendering service in collaboration with a physician (listed in Reserved for Local Use field)	Enter the applicable procedure code with modifier 99 in the Procedures, Services, or Supplies field (Box 24D). In theReserved for Local Use field (Box 19) enter “99 = SA + [additional modifiers as appropriate].”

The policy for each modifier will be transferred to its respective replacement modifier. The multiple modifiers used must be explained in theReserved for Local Use field (Box 19).

Claims with local NMP modifiers AN, YU, YR and YT will be denied for dates of service on or after February 1, 2009. Providers are also reminded that local modifier YS was end-dated effective October 2005. Claims billed with modifier YS will also be denied.

Manual pages reflecting this policy will be released in a future Medi-Cal Update.