United Healthcare to Require Anatomical Modifiers

Beginning with claims submitted on or after May 1, 2018, care providers will be required to include an anatomical modifier that identifies the area or part of the body for procedures performed on the eyelids, fingers or toes. This coding edit is consistent with Centers for Medicare & Medicaid Services (CMS) correct coding guidance and will be addressed in UnitedHealthcare’s Procedure to Modifier Policy. The corresponding anatomical modifier requirement will be applicable as additional procedure codes and/or modifiers are created.

Eyelid, finger and toe procedure codes reported without the modifier will be denied. Services will be denied and claims can be resubmitted with the appropriate modifier. Please refer to United Healthcare’s administrative guides for claim correction and resubmission information. A sampling of procedure codes and required modifiers is provided in the following table:


Procedure code Procedure description Modifier code Modifier description
67850 Treat eyelid lesion E2 Lower left, eyelid
26951 Amputation of finger/thumb F1 Left hand, second digit
28510 Treatment of toe fracture T8 Right foot, fourth digit


For your reference, here is a list of all applicable anatomical modifiers:

E1           Upper left, eyelid                             F9           Right hand, fifth digit

E2           Lower left, eyelid                             FA           Left hand, thumb

E3           Upper right, eyelid                          T1           Left foot, second digit

E4           Lower right, eyelid                           T2           Left foot, third digit

F1           Left hand, second digit                   T3           Left foot, fourth digit

F2           Left hand, third digit                       T4           Left foot, fifth digit

F3           Left hand, fourth digit                    T5           Right foot, great toe

F4           Left hand, fifth digit                         T6           Right foot, second digit

F5           Right hand, thumb                           T7           Right foot, third digit

F6           Right hand, second digit                T8           Right foot, fourth digit

F7           Right hand, third digit                     T9           Right foot, fifth digit

F8           Right hand, fourth digit                  TA           Left foot, great toe