UnitedHealthcare to Require Functional Limitation Reporting

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
February 21st, 2015

Effective August 1, 2014, the UnitedHealthcare Medicare Advantage Plans from UnitedHealthcare will implement the new Medicare Outpatient Therapy Functional Limitation Reporting requirement. The reporting scenarios will be similar to Medicare functional limitation reporting.

Announced in the UnitedHealthcare May 2014 Bulletin, contracted physical, occupational, and speech therapist claims with dates of service on or after August 1, 2014 will require Medicare Outpatient Therapy Functional Limitation Reporting codes be appended when one or more of the following CPT (current procedural terminology) codes are billed:

92521 92608 96105
92522 92610 96125
92523 92611 97001
92524 92612 97002
92597 92614 97003
92607 92616 97004

A therapy evaluation or re-evaluation CPT code listed above will require the addition of both a functional G-Code as well as the appropriate severity/complexity modifier (CH – CN). Any claims submitted with applicable CPT codes that do not contain the appropriate functional G-code and severity/complexity modifier(s) will be rejected and not processed.

Functional Limitation Reporting Suggestions

You should evaluate your current billing practices to ensure they align with the documentation in your patients’ medical records. If you are using WebPT, you need to edit the Insurance Company and check the Apply Functional Limitation Reporting check box. If you are using manual records, you need to treat the UnitedHealthcare Medicare Advantage insurance in the same manner as Medicare and report functional limitation reporting codes.


UnitedHealthcare to Require Functional Limitation Reporting. (2015, February 21). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/unitedhealthcare-to-require-functional-limitation-reporting-2471.html

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