UHC Policy Updates for 2026 

The following coding policies have been revised. 

Policy Title: Professional/Technical Component Policy, Professional 

Effective Date: April 1, 2026 

 Summary of Changes: Effective for dates of service on or after April 1, 2026, UnitedHealthcare will enhance the Professional/Technical Component Policy, Professional. When a radiology service is rendered and the physician or other eligible qualified healthcare professional performs a review rather than the full written interpretation and report, the reimbursement for the professional component is considered included in the Evaluation and Management (E/M) service. This will occur whether the radiology service is billed globally or with modifier 26. 

• Effective October 1, 2024, the Professional/Technical Component Policy was enhanced so the interpretation of a radiology service appended with modifier 26 would not be considered for separate reimbursement when reported on the same date of service as an E/M service for the same patient by the same provider unless a copy of the radiology report was attached to support separate reimbursement
• With the current enhancement, when a global radiology code is billed on the same date of service as an E/M service for the same patient, by the same individual provider, the global radiology code’s professional component will not be considered for separate reimbursement unless a copy of the radiology report is attached to support separate reimbursement
  • For example, if an internal medicine provider bills for an E/M service and a global radiology service, the provider would need to submit the report for the professional component of the global radiology service to be considered for separate reimbursement 

• To help providers submit an interpretation report, a Smart Edit will be implemented which provides additional details regarding the process for submitting the full interpretation report. 

Policy Title: Anatomical Modifier Requirement Policy, Professional – Reminder 

Effective Date: February 1, 2026 

Summary of Changes: Effective with dates of service on or after February 1, 2026, UnitedHealthcare will enhance the Anatomical Modifier Requirement Policy, Professional to align with the Center for Medicare and Medicaid Services (CMS) requirement that the appropriate laterality and/or anatomical modifiers be applied to surgical and radiological codes. 

• Surgical Codes (10000-69999 Series)
  • For codes related to a specific digit, the correct anatomical or laterality modifier must be used (FA, F1-F9, TA, T1-T9, LT, RT, 50).  
  • For codes not related to a specific digit, the appropriate laterality modifier (LT, RT, 50) must be used when applicable.  
• Radiological Codes (70000 Series)
  • For codes related to a specific digit, the correct anatomical or laterality modifier must be used (FA, F1-F9, TA, T1-T9, LT, RT, 50).  
  • For codes not related to a specific digit, the appropriate laterality modifier (LT, RT, 50) must be used when applicable.  

Modifiers play a critical role in medical coding by enhancing clarity and specificity. Submitting the appropriate modifiers to specify the exact area of the body where a procedure was performed helps eliminate the concern of duplicate billing and/or unbundling and helps ensure accurate reimbursement for the services rendered. 

Policy Title: Diagnosis Code Requirement Policy, Professional and Facility – Reminder 

Effective Date: March 1, 2026 

Summary of Changes: In the January 2024 Reimbursement Policy Update Bulletin, UnitedHealthcare (UHC) communicated implementation of a comprehensive Diagnosis Code Requirement Policy for both professional and facility services. This policy consolidated multiple diagnosis-related policies into one unified framework, aligning with existing ICD-10-CM guidelines. As part of that notification, UHC emphasized adherence by all providers to Excludes 1 coding rules, which are integral to the ICD-10-CM framework. At the time of the initial notification, these guidelines applied only to inpatient claims.   

• Excludes 1 guidelines indicate that certain codes are mutually exclusive, meaning they represent conditions that cannot be reported together — such as a congenital form versus an acquired form of the same condition. All providers must ensure compliance with Excludes 1 guidelines when submitting any type of claim 
• UHC will begin enforcing the application of Excludes 1 guidelines across all claim types effective March 1, 2026, to include outpatient and professional claim types. For additional details, please refer to the updated Diagnosis Code Reimbursement Policy   
• All providers must submit claims accurately in accordance with ICD-10-CM guidelines, including proper application of Excludes 1 rules. Claims that do not comply with these requirements may be subject to edits or denials 

The complete library of UnitedHealthcare Commercial Reimbursement Policies is available UHCprovider.com > Coverage and payments > Policies and protocols > For Commercial Plans > Reimbursement Policies for UnitedHealthcare Commercial Plans.