New GA modifier requirement for UnitedHealthcare commercial plans

Beginning Feb. 1, 2025, we’re adding the following GA modifier requirement for UnitedHealthcare commercial plans claims to our Charging members for non-covered services protocol. This requirement should help improve health care transparency by helping to ensure patients were made aware of their potential cost-sharing liability.

The new requirement

In addition to the consent requirements in the Protocol, if you know or have reason to suspect that a commercial member’s benefits do not cover the service (as described further in the Protocol), a GA modifier must be submitted on the claim if you want to bill our member for the non-covered service. You will use the GA modifier to document when the enhanced content requirements of the consent were met. The aim of requiring use of the GA modifier is to improve health care transparency by helping ensure members were made aware of their potential liability in advance of any procedure or bill they may receive for services. If you didn't meet all of the consent requirements in the Protocol, it is not appropriate to submit the GA modifier on the claim and you cannot bill our member.

What you need to do

If you obtain written consent from a commercial member for a service you know or suspect is not covered by their benefits, and the consent met all the requirements in the Protocol, you must include the GA modifier on your claim for the non-covered service. Including the GA modifier on your claim for the non-covered service helps ensure it is adjudicated as member liability where appropriate.

Note, the new requirement will also be included in our 2025 Administrative Guide for Commercial Plans.

PCA-1-24-01371-POE-NN_07262024