Changes to UnitedHealthcare Billing

September 1st is
right around the corner...

Does Your Clinic Accept UnitedHealthcare Patients?

              Starting next month, when billing to UnitedHealthcare, all dates of service taking place on or after September 1 will require GP, GO, or GN modifiers attached to “Always Therapy” codes in order to align with CMS.

              According to CMS, specific codes are considered “Always Therapy” regardless of who they’re being performed by. As a result, these codes always require a designated therapy modifier to indicate that they are being provided under a PT, OT, or SLP plan of care.

              These “Always Therapy” modifiers are necessary in order to ensure accurate reimbursement for each particular type of therapy.

How Should You Prepare to Stay Compliant?

              If you are contracted with UHC and do not already have a specific UHC Contracted Fee Schedule in place, we recommend that you create one. After doing so, you will need to manually add the respective GP, GO, or GN modifiers to the “Always Therapy” codes that require them (the full list of required codes can be found here).

              If you already have a UHC Contracted Fee Schedule set up, you will still need to manually add those same required modifiers to your already-existing fee schedule.

              For a comprehensive, step-by-step guide on how to create a new fee schedule or adjust a preexisting one, please click here.

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