United and the -25 modifier (partial good news . . . for once)

November 1, 2007

aap

Announced by SOAPM and the AAP today:

United Healthcare (UHC) announced today that it will implement its Preventive Medicine Policy effective December 8, 2007. UHC will now pay for both a preventive medicine E/M service plus 50% of a problem-oriented E/M service when the problem-oriented service represents a significant, separately identifiable service and is submitted with modifier-25 appended.

The AAP has advocated for separate payment for both E/M codes and expressed dissatisfaction with UHC delays in implementation. Because of the advocacy of SOAPM members and others, UHC will adjust all
affected claims with a date of service as far back as October 15, 2007. Physicians will not need to adjust any of these claims as it will be done automatically.

Dr Lander and others will contiue to watch this situation closely to ensure that UHC abides by its commitment.

It's lame that they are only paying 50% (totally not CPT kosher), but it's a start. And, do we really think that "...Physicians will not need to adjust any of these claims as it will be done automatically"?

Still, good work Dr. Lander.

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United and the -25 modifier (partial good news . . . for once)

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