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Provider Modifier Grid

Product Information

UCare products include Commercial, Medicare, and Minnesota Health Care Programs (MHCP). For detailed information regarding the Plans covered under these products refer to UCare's website under health plans.

General Payment Information

The information provided below outlines the impact appending a specific modifier will have on payment of professional claims. Payment for each eligible professional service is based on the lesser of charge, or the increase, decrease or change in payment that is specific to the modifier that has been appended to the service.


Modifiers are used as means to communicate that a service or procedure has been altered by some specific circumstance without changing the description of the service provided, communicate additional information regarding the provider performing the service, provide clarity regarding the service performed, or to meet specific payment policy requirements. Outlined below is general information regarding the use of modifiers and the impact the use of those modifiers may have on payment.

Additional Resources


Medicaid / MHCP


The following disclaimer applies to the modifier grid published by UCare and all of the UCare’s published attachments provided therein.

The examples provided above are for illustrative purposes only, and are not intended to be a guarantee of coverage or payment.

Payment policies assist in administering payment for UCare benefits under UCare’s health plans. Payment policies are intended to serve only as a general reference resource regarding UCare’s administration of health benefits and are not intended to address all issues related to payment for health care services provided to UCare members. In particular, when submitting claims, all providers must first identify member eligibility, federal and state legislation or regulatory guidance regarding claim submission, UCare provider participation agreement contract terms, and member specific Evidence of Coverage (EOC) or other benefit documents. In the event of a conflict, these sources supersede the Payment Policies. Payment Policies are provided for informational purposes and do not constitute coding or compliance advice. Providers are responsible for submission of accurate and compliant claims. In addition to Payment Policies, UCare also uses tools developed by third parties, such as the Current Procedural Terminology (CPT®*), InterQual guidelines, Centers for Medicare and Medicaid Services (CMS), the Minnesota Department of Human Services (DHS), or other coding guidelines, to assist in administering health benefits. References to CPT© or other sources in UCare Payment Policies are for definitional purposes only and do not imply any right to payment. Other UCare Policies and Coverage Determination Guidelines may also apply. UCare reserves the right, in its sole discretion, to modify its Policies and Guidelines as necessary and to administer payments in a manner other than as described by UCare Payment Policies when necessitated by operational considerations.”

*CPT® is a registered trademark of the American Medical Association