Insurance

United to Require GP Modifier as of July 1, 2019

Beginning July 1, 2019 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 April 2019 (page 25) and United advises that a letter was sent to providers in April.  A copy of this letter can be viewed here .

You may have received a denial for not having this modifier in the last few weeks.  United has advised the ANJC that due to a coding error the claim edit went into effect early.  The issue has been resolved and corrected payments should be in process.  If you have an outstanding denial for this reason, please email me at matt@anjc.info.