Insurance

United to Require GP Modifier as of April 1

After several delays, for dates of service on or after April 1, 2020, United Healthcare will require the GP modifier to be appended to any codes that are deemed “Always Therapy” codes according to CMS. 

These codes will include: 97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97110, 97112, 97113, 97116, 97124, 97139, 97140, 97150, 97530, 97533, 97535, 97537, 97542, 97750, 97755, 97760, 97761, 97762*, 97799, G0281, G0283. 

This policy changed was announced in the United Network Bulletin January 2020 (page 39).  A copy of the letter which originally announced this change in mid-2019 can be viewed here .

This change should not affect coverage or reimbursement.  If you receive any denials or reductions in reimbursement following this implementation or if you have any other questions regarding this policy please contact me at matt@anjc.info.