Wiki Nutrition with an NP and UHC Insurance

[ValerieSMiller]

I am new to nutrition coding and having a rough go of it - you would think it would be easy... I keep getting denials for our NP with United Health Care for 98960-GT and 98968-GT for telehealth. We are using the 02 place of service. I believe I saw something that an ABN needs to be on file, but how does that work with telehealth?

Ugh.

 

[SharonCollachi]

I don't think ABN is your issue, and you said UHC, not Medicare, so the ABN is irrelevant.

However, UHC does follow Medicare guidelines. Have you checked those?

What exactly are your denials, what is the diagnosis code, and is your NP accredited as a Nutritionist? (is this for diabetic nutrition?)

 

[nrood]

Just throwing this out there, UHC wants the GQ modifier and Office POS (11) for telehealth. That is what we have been using for our telehealth services for that insurance company and have not had any issues. What was your denial reason? Judging by what you have mentioned only, and assuming all credentialing for NP is good, I would recommend pulling up UHC guidelines for how they would like telehealth claims billed to them. It seems like a lot of insurance companies have their own version on how they want things done and not all of them are accepting the 95 modifier. Some want GT or GQ instead and some want telehealth POS, but others want office.