UnitedHealthcare – Revision to the Procedure to Modifier Policy

February 2018 ~

As of May 1st, UnitedHealthcare (UHC) will require procedures performed on the eyelids, fingers or toes to include an anatomical modifier that identifies the area or part of the body on which the procedure is performed.

Beginning with claims submitted on or after May 1st, eyelid, finger and toe procedure codes reported without the modifier will be denied and services will be denied and claims can be resubmitted with the appropriate modifier.

According to the insurer, this coding edit is consistent with CMS correct coding guidance and will be addressed in UHC’s Procedure to Modifier Policy. The corresponding anatomical modifier requirement will be applicable as additional procedure codes and/or modifiers are created.

UHC provided the following sampling of procedure codes and required modifiers:

For claim correction and resubmission information, refer to Chapter 9 of the 2018 UnitedHealthcare Care Provider Administrative Guide.


Source(s): UnitedHealthcare Network Bulletin;