New Requirement for Using the GA Modifier with United Healthcare Claims in 2025

As of February 1, 2025, UnitedHealthcare commercial plans will implement a new requirement mandating the use of the GA modifier on claims for non-covered services billed to patients. This update is part of their Charging Members for Non-Covered Services initiative, designed to promote greater transparency and ensure patients are fully informed of any potential out-of-pocket expenses.

Here’s what you need to know: If a service is either not covered or you believe it falls outside of the member’s commercial benefits, you must secure written consent from the patient that aligns with the detailed guidelines in UnitedHealthcare’s protocol. Once this consent is obtained, the GA modifier should be included on the claim to confirm the patient has been notified of their financial responsibility.

A critical point to remember: If the required consent isn’t obtained or doesn’t meet the established standards, the GA modifier cannot be used, and you are not allowed to bill the patient for the non-covered service. Proper adherence to this protocol is key to ensuring claims are processed correctly and preventing disputes related to billing.

To remain compliant, take the time to review UnitedHealthcare’s updated guidelines and integrate the GA modifier into your claims workflow when dealing with non-covered services. By doing so, you’ll protect your practice while supporting patient understanding and trust.