we have been billing CPT 99243 (or other E/M codes) and CPT 93971 for many years and have been getting reimbursed for both. During the last year of so, United Healthcare (NY) has stopped paying for CPT 99243 stating that this code requires a referral in order to receive reimbursement. Our surgeons are out of network so we don't need referrals for these out of network plans. Also, it had helped to use modifier 25 with 99243 and modifier 59 with 93971 but now this is no longer accepted. Has something changed?