Beginning February 1, 2025, UnitedHealthcare (UHC) is implementing a new requirement for claims submitted under their commercial plans. This update affects how providers bill patients for non-covered services, and it includes a new protocol for using the GA modifier to improve cost transparency and ensure proper patient notification.
At CloudRCM Solutions, we’re committed to helping your practice stay compliant and efficient with evolving payer requirements. Below is a breakdown of the new UHC billing guideline and what you need to do to remain compliant.
What Is Changing?
As of February 1, 2025, UHC will require providers to add the GA modifier to claims when billing a patient for services that are known or suspected to be non-covered by their UHC commercial plan. This applies only when:
The provider obtains written informed consent from the patient
The consent meets all requirements outlined in UHC’s Charging Members for Non-Covered Services Protocol.
The GA modifier serves as a signal that the patient was fully informed of their potential financial responsibility before the service was rendered.
Purpose of the GA Modifier Requirement
UHC is introducing this rule to promote greater transparency in healthcare billing. The use of the GA modifier ensures that patients are:
- Informed in advance that a service may not be covered by their insurance
- Aware they may be personally responsible for the cost
- Given the opportunity to consent in writing before the service is performed
Without the proper use of the GA modifier and written consent, providers cannot bill the patient for the non-covered service.
When to Use the GA Modifier
You must append the GA modifier to a claim only if:
You know or have reasonable reason to suspect that the service is not covered by the patient’s UHC commercial plan.
You have obtained written consent from the patient acknowledging:
The service may not be covered
They agree to pay out-of-pocket
The consent meets all of UHC’s Protocol requirements.
If all criteria are met, you may submit the claim with the GA modifier, and the service will be processed accordingly with member liability applied.
Important: If the consent process was not followed exactly as described in the Protocol, you may not use the GA modifier and you cannot bill the patient.
Where to Find This Policy
This requirement will be included in UHC’s upcoming 2025 Administrative Guide for Commercial Plans. Providers are encouraged to review the Protocol carefully to ensure full compliance.
What Providers Should Do Now
To prepare for this change:
Train your billing and front-office teams on the updated requirement
Review and update your patient consent forms
Ensure clear documentation when services may not be covered
Begin integrating the GA modifier into your billing workflow when applicable
How CloudRCM Solutions Can Help
Navigating payer policy changes can be time-consuming and complex. That’s where CloudRCM Solutions steps in. Our billing experts will:
Ensure your claims include the correct modifiers
Help you stay compliant with payer requirements
Minimize denied claims and revenue loss
Keep your documentation and consent process aligned with updated protocols
We proactively monitor changes like these so your practice stays compliant, gets paid faster, and maintains trust with your patients.
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