United Healthcare 51 modifier

DEDGE CGIC

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Does anyone know when and why United health care is no longer ackonowledging the 51 modifier?

Per their re-bundling policy and the rep I spoke with this is off their site:

Modifiers

Modifiers offer the physician or healthcare professional a way to identify that a service or procedure has been altered in some way. Under appropriate circumstances, modifiers should be used to identify unusual circumstances, staged or related procedures, distinct procedural services or separate anatomical location(s).

UnitedHealthcare recognizes the following designated modifiers under this reimbursement policy:
25, 50, 58, 59, 78, 79, 91, E1, E2, E3, E4, LC, LD, LT, RC, RT, TA, T1, T2, T3, T4, T5, T6, T7, T8, T9, FA, F1, F2, F3, F4, F5, F6, F7, F8 and F9.

Modifiers offer specific information and should be used appropriately. It is inappropriate to use modifier 76 to indicate repeat laboratory services. Modifiers 59 or 91 should be used to indicate repeat or distinct laboratory services, as appropriate, according to the AMA and CMS. Separate consideration for reimbursement will not be given to laboratory codes reported with modifier 76.

51 is not listed and we are starting to get more and more bundling denials connected to this issue.
 

jmcpolin

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Most insurance companies including medicare do not recommend using the 51 modifier because their system automatically reduces the second procedure.
 

ollielooya

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The use or lack of use of this modifier has caused a lot of confusion and on anothe list to which I belong, there tend to be a "consensus of members" to get this removed altogether from CPT. Many say not to use it at all, but there are some carriers still out there who want and expect it. Once again, it is payer specific and should be addressed in this manner. As far as UHC is concerned, I suspect this policy excluding modifier 51 has been in effect for some time?
 

ewinnacott

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I usually just let the insurance companies add it because the times I have added it, they add it too and it becomes a double modifier -51 and the claim gets denied. I wouldn't bother adding it unless it is specifically requested
 

weigelm

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I was told from UHC customer service that this changed after an AMA decision on 05/18/14. What I am wondering is what modifier are we supposed to use now? No one at UHC will tell me, and when I look at the website for unitedhealthcareonline.com I still see info stating modifier 51 is needed. If anyone knows what we are supposed to use now for a modifier 98943 I would really appreciate it.
 
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