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Wiki United Healthcare & MPPR

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AKSpectrum

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Does anyone have experience with billing United Healthcare (not Military - Tricare), PT/OT CPTs and have them pay on multiple units? It does depend on the beneficiary's plan, but I have some that they are paying for the 1st unit of 3 or 4 units, and denying the rest of the units with the MPPR rule. So basically, they are only paying for 15 min of PT/OT therapy. I've recently started using 59 modifier to see if they will pay for the rest of the units. The patient is not seeing another therapist on the same day, and usually, there are not other CPT codes billed on the claim.

Any insight as how to work around their rule would be greatly appreciated!
 
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