New GA Modifier Requirement Now in Effect for UnitedHealthcare Commercial Plans
UnitedHealthcare will enforce a new GA modifier requirement for commercial plans when billing claims as part of the Charging Members for Non-Covered Services protocol starting on February 1, 2025. As the Administration continues working to increase price transparency in healthcare, this regulation will help alert patients upfront of their potential cost-sharing liabilities.
The New Requirement
However, in addition to the consent requirements as stated in the protocol, if the provider is aware or has reasons to believe that a commercial member’s benefits do not entitle him or her to a certain service as provided in the protocol, the GA modifier has to be included with the claim to charge the member for such a service.
The GA modifier will also be used to report that the higher consent standards that were put in place have been fulfilled. The rationale for this requirement is to make the members aware of their possible exposure to risk before any procedure or billing is done. If all the consent requirements in the protocol are not met, then the GA modifier should not be submitted, and the member cannot be billed.
What Providers Need to Do Now!
Suppose written consent is obtained from a commercial member for a service known or suspected to be non-covered, and the consent meets all protocol requirements. In that case, the GA modifier must be included on the claim for the non-covered service. Including the GA modifier ensures the claim is adjudicated as member liability where appropriate. The 2025 Administrative Guide for Commercial Plans will also include this new requirement.