United Healthcare Announces Coordinated Commercial Reimbursement Policy Changes

May 2019 ~

UnitedHealthcare (UHC) has released changes to its coordinated commercial reimbursement policy, which includes updates to its procedure to modifier policy and consultation services policy. An overview of the policy changes and their effective dates can be seen below.

Policy: Procedure to Modifier Policy, Professional

Effective Date: July 1, 2019

Summary of Change:

• Effective with dates of service on or after July 1, the GN, GO or GP modifiers will be required on “Always Therapy” codes to align with CMS.
• According to CMS, certain codes are “Always Therapy” services regardless of who performs them, and always require a therapy modifier (GP, GO or GN) to indicate they’re provided under a physical therapy, occupational therapy or speech-language pathology plan of care.
• “Always Therapy” modifiers are necessary to enable accurate reimbursement for each distinct type of therapy in accordance with member group benefits.

Policy: Consultation Services Policy, Professional

Effective Date: July 1, 2019

Summary of Change:

• As previously announced in the March and April 2019 Network Bulletins, UHC is revising the Consultation Services Policy and will no longer reimburse CPT^® codes 99241-99255.
• Effective with dates of service of June 1, UHC will no longer reimburse CPT codes 99241-99255 when billed by any health care professional or medical practice with a participation agreement that includes contract rates determined on a stated year 2010 or later CMS RVU basis.
• Effective with dates of service of Oct. 1, 2019, UHC will no longer reimburse CPT codes 99241-99255 when billed by any health care professional or medical practice.
• When services are rendered at the request of another physician or appropriate source, care providers should submit an appropriate E/M service in alignment with either the 1995 or 1997 CMS coding guidelines.
• With respect to telehealth and telemedicine services, the Telehealth & Telemedicine Policy will continue to apply and HCPCS codes G0406 – G0408, G0425 – G0427, G0508 and G0509 will be payable pursuant to that policy, the participation agreement and the member’s benefit plan.
• A video presentation with more information can be viewed on UHC On Air. Additionally, a course for CEU/CME credits entitled “Evaluation and Management Coding: Back to Coding Basics” is also available through Link on UHCprovider.com.
• UHC would like to continue partnering with care providers on older fee schedules (2009 and prior) to move to more current fee schedules. Care providers with questions about their fee schedule may reach out to their UnitedHealth Network representative.

Source(s): UnitedHealthcare Network Bulletin;