UnitedHealthcare to Implement GA Modifier Requirement

January 27, 2025
 / 
Rick Gawenda
 / 

UnitedHealthcare has announced they will be adding the GA modifier requirement. In this article, I will answer the following questions:

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  1. For example, since they do not cover Dry Needling, we need to bill the code to UHC with GA and then we can collect from them once the claim is processed by UHC with patient responsibility? Or are we able to continue making them pay up front DN?

    1. Refer to the 2025 Administrative Guide for Commercial Plans in the answer to the last question in this article.

  2. We offer cash pay services that we never bill insurance. For example, we have a massage therapist. Patients sign a form electing this service and acknowledging it will be cash per per visit. Is this required to be submitted? We have a Class IV laser that does not have a corresponding CPT code, we also bill this as a cash service and the patient signs a form electing this and acknowledging it will be a cash pay per visit.

  3. Is there a specific Section of the 2025 Admin guide to reference specific to this GA code? I’d like to reference the specific verbiage to share with my collegues.