United Healthcare to Require Therapy Modifiers

Updated June 3, 2019

United Healthcare announced in their May Bulletin that effective with dates of service on or after July 1, 2019, they will be requiring therapy modifiers on all “always therapy” codes. The policy language is below and can be found on page 24 of the bulletin. In their June 2019 Network Bulletin, United Healthcare announced that they are delaying implementation until September 1, 2019. The announcement can be found on page 20 of the bulletin.

• Effective with dates of service on or after September 1, 2019, 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 they always require a therapy modifier (GP, GO, or GN) to indicate they’re 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.
• To avoid claims denials, be sure to adjust your billing process to add the modifiers effective with September dates of service.