UnitedHealthcare Implements Enhancements to Procedure to Modifier Policy

February 2020 ~

In their February 2020 Network Bulletin, UnitedHealthcare (UHC) announced plans to implement certain changes to enhance the Procedure to Modifier Policy for Medicare Advantage plans to include modifiers CT, FX and FY.

These changes pertain to Medicare Advantage Plan reimbursement policies for services reported using the 1500 Health Insurance Claim Form (CMS-1500) or its electronic equivalent or its successor form. According to the announcement, consistent with CMS regulations, the insurer will make the following changes to its Procedure to Modifier Policy for Medicare Advantage plans:

Modifier CT:

– CAT scans furnished on non-NEMA Standard XR-29-2013-compliant equipment

– Payment reduction of 15% will be applied to the technical component (TC) payment portion

Modifier FX:

– Imaging services that are X-rays taken using film

– Payment reduction of 20% will be applied to the TC payment portion

Modifier FY:

– Imaging services that involve cassette-based imaging which utilizes an imaging plate to create the image

– Payment reduction of 7% will be applied to the TC payment portion

Additionally, effective for claims with dates of service on or after April 1, 2020; UHC will implement reductions to the TC payment (and the TC portion of the global fee) portion of radiological services when appended with the CT, FX or FY modifiers.

For more information, see the CMS Change Request notice, here.

Source(s): UnitedHealthcare Network Bulletin, February 2020;