Effective Feb. 1, UnitedHealthcare (UHC) will require physician practices to append the GA modifier to commercial plan claims for services they know or suspect are not covered. UHC says this change will enhance health care transparency by ensuring patients are informed of potential out-of-pocket costs in advance.
Understanding the GA modifier requirement
The GA modifier indicates that a practice has obtained a patient's written consent acknowledging their financial responsibility for a non-covered service. Failure to secure consent and indicate it using the modifier will prohibit practices from billing the patient for the service.
Action steps
To comply with this new requirement:
1. Educate staff: Ensure clinical and administrative staff are aware of the requirement and implement a process to ensure compliance.
2. Assess coverage: Determine if the service is covered under the member's benefits.
3. Obtain consent: If the service is likely not covered, secure written consent from the patient. Generic, blanket, or blank consent forms are not allowed. The consent must include:
4. Maintain records: Keep a copy of the consent in the patient medical record.
5. Use the GA modifier: Include the GA modifier on the claim to indicate that you obtained proper consent.
Additional Information
More details are available in UHC's 2025 Administrative Guide for Commercial Plans. For further assistance, practices can access 24/7 support through the UHC’s Provider Portal.
— Brennan Cantrell, AAFP Senior Strategist, Market Transformation
Posted on Jan. 14, 2025
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