UnitedHealthcare Issues Recent Commercial Reimbursement Policy Updates

August 2019 ~

Effective September 1, UnitedHealthcare (UHC) will add a new policy for molecular pathology and will make changes to its procedure to modifier policy.

Policy: Procedure to Modifier Policy, Professional

Effective Date: September 1, 2019

Update: Effective with dates of service on or after September 1, the GN, GO or GP modifiers will be required on “Always Therapy” codes to align with the Centers for Medicare & Medicaid Services (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 that they are 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: New Molecular Pathology Policy, Professional

Effective Date: September 1, 2019

Update:

  • The new Molecular Pathology Policy will be effective beginning with dates of service on and after Sept. 1, 2019.
  • Corrections from the June 2019 Network Bulletin:
    • The AMA Claim Designation code or Abbreviated Gene Name should be reported in Loop 2400 or SV101-7 field for electronic claims or Box 24 for paper claims. For identification, the ZZ qualifier is required in front of the Claim Designation code or Abbreviated Gene Name (ex: ZZCLRN1).
    • The Genetic Test Registry (GTR) unique ID should be reported in loop 2400 or SV101-7 field for electronic claims or in Box 24 for paper claims (ex: GTR123456789).
  • Claims that have complied with notification or prior authorization requirements in UnitedHealthcare’s Genetic Testing and Molecular Prior Authorization Program satisfy the policy’s requirements without further provider action if they meet UnitedHealthcare’s Genetic Test Lab Registry requirements.

According to the insurer, the policy changes listed above are part of UHC’s ongoing effort to improve health care quality and affordability for members while managing the appropriate use of certain services.

 

For more information and complete details on these changes, refer to UHC’s Commercial Reimbursement Policies page.

 

 

Source(s): UnitedHealthcare Network Bulletin, August 2019;
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