New UHC/Optum Modifier Requirements for Therapy

Earlier this summer, some of our members’ claims were impacted when a UHC/Optum system glitch applied a processing policy that had not yet taken effect. Soon thereafter, UnitedHealthcare reprocessed all of those claims appropriately and then delayed the implementation of the new modifier policy to September 1, 2019 (previously July 1).

The new policy requires the modifiers GN, GO, or GP on physical therapy codes, beginning this Monday (9/1/2019). According to ICS contacts at UHC/Optum, this policy will apply to all UHC plans including commercial AND Medicare Advantage. Additionally, it will apply to both participating and non-participating providers.

Advertisement

Most of our doctors will be utilizing the GP modifier, which identifies services rendered under a physical therapy treatment plan. However, if you deliver occupational therapy services (GO modifier) or speech therapy services (GN modifier), you will be required to use modifiers other than GP.
Additionally, Optum has identified these CPT® codes and their related modifiers:

GN, GO or GP Modifier according to the treatment plan

97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036 , 97039, 97110, 97112, 97113, 97116, 97124, 97139, 97140, 97150, 97530, 97533, 97535, 97537, 97542, 97750, 97755, 97760, 97761, 97763, 97799, G0281, G0283, and G0329.

GP Modifier only

97161, 97162, 97163, and 97164.

GO Modifier only

97165, 97166, 97167, and 97168.

To view the entire policy statement, please see the policy online.