UHC to Require Therapy Modifiers for Reimbursement

June 4, 2019
Rick Gawenda

This article was originally published on May 20, 2019. Information has been updated as of June 3, 2019. Please read below for further details.

Changes are coming to UnitedHealthcare and billing for outpatient therapy services. Failure to be aware of this change will cause your claims not to be paid beginning this summer.

UHC has announced they will begin requiring the application of the therapy specific

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  1. I am not sure I understand what an “always code” is versus a “sometimes code.” The links to the information were very confusing.

    1. “Always code” means that CPT code is always considered a therapy code, regardless of who provides it. A “sometimes code” means it’s only considered a therapy code when provided by a PT, OT or SLP under a therapy plan of care.

        1. If you read the article, it gives you a link where you can download the excel spreadsheet and it will tell you what CPT codes are “Always Therapy” CPT codes and which ones are “Sometimes Therapy” CPT codes. For example, CPT code 95992 (Canalith Repositioning) is considered a “Sometimes Therapy” CPT code. When Canalith repositioning is performed by a physical therapist under a PT plan of care, it’s considered a therapy CPT code. If provided by a physician not under a therapy plan of care, it’s not considered a therapy CPT code.

  2. Would an ATC be eligible to use a GP modifier if they established the therapy plan of care? Thank you!