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  • UnitedHealthcare Delays Requirement for Functional Limitation Reporting

    UnitedHealthcare (UHC) is delaying implementation of a plan to require functional limitation reporting (FLR) for physical therapy, and has not announced a new launch date. APTA remains opposed to UHC's intention to move to FLR.

    UHC announced its original decision to implement FLR in May. The company had planned to require G-codes and severity/complexity modifiers on contracted PT claims with dates of service on or after August 1, 2014. Those changes have been put on hold indefinitely.

    In a July letter, APTA urged UHC to stop its plan to implement the requirements, arguing that the difficulties experienced by physical therapists (PTs) during Medicare's changeover to the requirements, as well as limitations in data, made UHC's planned August 1 move ill-advised.

    APTA offers a functional limitation reporting webpage that provides resources to help members understand these requirements.


    • Is there a reference you can share regarding this information. There is nothing on UHC website about the G code requirement being put on hold. And when calling UHC to validate this information the representative stated she knows nothing about this being put on hold. Thank you!

      Posted by Julie Moore on 8/5/2014 8:24 AM

    • The "reporting standard" of the GCodes by medicare is a poorly conceived model. We all need to react with outrage when/if they ever base reimbursement on progress from one modifier to another. What about those medicare beneficiaries whose function we are trying to maintain or slow the decline of (Jimmo v Sebelius)? UHC obviously was convinced that this is not the right way to report functional outcomes. Private insurers are right to wait until a better system is conceived.

      Posted by Joel Dykstra -> =JRaEL on 8/5/2014 10:05 PM

    • I am not able to find anything online in general or on UHC site indicating this suspension either. Please provide reference to any statement by UHC that can support this. We would prefer not to report G Codes when not necessary.

      Posted by Gary Maguire -> BLS[DN on 9/4/2014 1:00 PM

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