UHC denies Modifier 59 for PT

Hi all,

Has anyone solved for this in the past?

I've been struggling for the past 3 months to have UHC reimburse me for outpatient physical therapy following an injury. My provider and I are at a dead end because we submitted everything the way UHC asked us to yet UHC rejects the requests. ANY HELP IS APPRECIATED.

Procedure codes: 97161 – Physical Evaluation 97140 Manual Therapy 97110 Therapy Exercises

I submitted a claim for each service date. Usually during a visit, the provider performed 2 of the above after each other, i.e. first manual Therapy then exercises.

I read online that in order to get reimbursed. modifier 59 must be used to indicate that another procedure was performed during the same visit but that the procedure is distinct and independent. Which I did but which was rejected.

This was denied twice now and UHC does not provide an explanation or reason, other than "incorrect modifier". Speaking to claims agents is a waste of time.

Finally I spoke to a UHC supervisor who actually tried to help me, and who told me that UHC does not accept 59 modifier – contrary to their website listing. He further mentioned, but was "not allowed to say",, that the modifier needs to be "GP" for physical therapy. So, when I resubmit the claims with my provider, do we need to put modifier GP on each of the 3 procedure codes above?

Thanks in advance!

submitted by /u/Kemis7
[comments]