Three United Healthcare Policy Changes You Need to Implement

United Healthcare is rolling out three significant policy updates in early 2026 that will impact claim processing and reimbursement. Here's what you need to know:

Anatomical Modifiers are Now Required (Starting February 1, 2026)

UHC is implementing mandatory anatomical modifier requirements to align with CMS standards. Claims for surgical and radiological procedures must include proper laterality and anatomical modifiers to avoid denials and ensure correct payment.

Key modifiers include FA, F1-F9, TA, T1-T9, LT, RT, and 50. We also suggest tracking modifiers E1-E4, LC, LD, LM, and RC.  Affected procedure codes: CPT codes 10000-60000 (surgical) and 70000 series (radiology)

Excludes1 Coding Rules Enforcement (Starting March 1, 2026)

UHC will begin enforcing ICD-10-CM Excludes1 guidelines for all claim submissions, outpatient and professional.

What this means: Excludes1 designations indicate mutually exclusive diagnoses that generally cannot coexist (such as congenital versus acquired versions of the same condition). These diagnosis codes cannot appear together on the same claim.

Important exception: When two conditions are clearly unrelated despite an Excludes1 designation, both may be reported. When there's uncertainty about the relationship between conditions, clarify with the treating provider before submission.

Radiology Interpretation Documentation Requirements (Starting April 1, 2026)

Professional radiology components will only be reimbursed when accompanied by complete interpretation reports, not just notation within E/M visit documentation.

Required elements for reimbursement:

·       Documented images in the patient's medical record

Standalone interpretation report (separate from visit notes) containing written findings and supervision details when imaging is not included in the procedure description.

Sources:

United Healthcare Policy Updates, January 2026

2026 ICD-10-CM Coding Guidelines

CPT 2026