As previously reported, United Healthcare and its subsidiaries will require the GP modifier to be appended to any codes that are deemed “Always Therapy” codes according to CMS for dates of service on or after April 1, 2020.
As we have previously reported to you, Inovalon is a company that is collecting patient records to perform risk adjustment reviews on behalf of Horizon. Risk adjustment reviews are reports required by and provided to the government as dictated by the Patient Protection and Affordable Care Act (PPACA aka Obamacare). All carriers collect data for these reports and in the years these have been required we have not yet seen a negative consequence for any provider stemming from these record collections.
You may have seen articles recently announcing an agreement between Senate President Steve Sweeney and the NJEA on changes to the School Employee Health Benefits Program. There are many details not yet available regarding these changes but here is a breakdown of what we know at this point.
We had previously advised membership that Medicare had begun covering acupuncture in certain specified situations as of Jan. 21, 2020. Acupuncture is to be allowed for chronic low back pain for 12 visits with an additional eight if improvement is shown, with no more than 20 visits allowed annually.
After several delays, for dates of service on or after April 1, 2020, United Healthcare will require the GP modifier to be appended to any codes that are deemed "Always Therapy" codes according to CMS.