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united healthcare denial

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catooch:
I have a question on united healthcare.  I just received a denial because they need a modifier for codes 97010, 97014, 98941.  What would be the appropriate modifier for these codes.  They said if the received this they will probably pay.

Thank you for your help.
Cathy, NY

Metrehab:
I received a similar EOB from UHC in the past and I tried re-billing with Modifier-GP (services rendered under Outpatient Physical Therapy plan of care) unfortunately, UHC still did not pay.
I later found out that United Health Care does not pay for 97010 (hot/cold packs).
Also, they don't use 97014 anymore for E-Stim, they use is G0283.
As far as 98941, I am not familiar with that code, I work for a physical therapy clinic.
Anyway: Good luck.
Stacie Bacon

Michele:
Hi Cathy,
   Is the UHC you are billing one of the Medicare Managed Care Plans?  If so, they require the AT modifier just like Medicare does.  They will only pay on the 98941 code (chiropractic manipulation) just like Medicare.

   If it is not a Medicare Managed Care Plan then I am not sure what modifier they would want.  I'm assuming your billing for a chiropractor so the GP wouldn't be appropriate but Stacie is right, UHC doesn't allow the 97010 and they use the G code for the 97014. 

    If the AT modifier is not what they are looking for then I would call your UHC provider rep and ask them for a little help.

Good luck
Michele

corriejo:
98941 is for manual manipulation (if you bill it with a 98943 you want to use modifier -51 on the 98943). As far as the 97... codes go, you want to modify them (both) with a -59, if you're billing along with the 98941.  hope that helps

kmoore:
Ok I am new at medical billing and just signed my first chiropractic client.  One of his patients is a UHC patient and the following codes are on this dr's superbill CPT 98941, 98943 with modifier 51, 97010, 97012, 97014, & 97140 with modifier 59.  Does this mean that if I submit this with DX codes of 739.5, 739.3, 739.3, & 719.48 that it will be denied because of UHC not paying for 97 codes or is there a way I can submit this that it will be paid?
Thanks for the help
Kim

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