UnitedHealthcare (UHC) Individual Exchange Plan has announced they will begin requiring additional modifiers be appended to CPT codes on both the 1500-claim form and UB-04 claim form in order for outpatient therapy services to be reimbursed. Failure to append the new modifiers on each CPT code will result in those claim lines being rejected.
The new modifiers that are required beginning with dates of service on and afterSeptember 1, 2021 are either Modifier 96 or Modifier 97. Modifier 96 is to be appended to the CPT code on the claim form to indicate that the service is Habilitative in nature and Modifier 97 is to be appended to the CPT code on the claim form to indicate that the service is Rehabilitative in nature.
If additional modifiers are required to be appended to a CPT code on the claim form in addition to Modifier 96 or 97, then those additional modifiers must also be reported. This may include the discipline specific modifier (GN, GO, GP) or modifier 59.
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