UnitedHealthcare posted its May 2026 Reimbursement Policy Update Bulletins on May 1, and the commercial bulletin contains one change that surgical practices should read twice. Starting with dates of service on or after June 1, 2026, UnitedHealthcare will pay procedures billed with modifier 78 at the CMS-designated intraoperative percentage for that specific code, rather than at a flat 84 percent of the allowed amount.
That sentence sounds technical. In dollars it is not. Modifier 78 is used when a patient has to go back to the operating room during the global period for a complication of the original surgery. The payer pays only the intraoperative portion of the procedure, because the pre-operative and post-operative work is already covered by the first surgery's global package. UnitedHealthcare has been paying that intraoperative portion at 84 percent for every code. CMS publishes a code-specific percentage in the National Physician Fee Schedule relative value file, and for many procedures it is well below 84.
The bulletin describes the change as aligning with CMS. That is accurate. It is also a rate reduction for most return-to-OR procedures, and practices should model it before June.
Key takeaways
- From June 1, 2026, UnitedHealthcare commercial plans pay modifier 78 claims at the CMS intraoperative percentage for the code, which the bulletin says ranges from 60 to 84 percent, instead of a flat 84.
- Pull 12 months of modifier 78 claims and recalculate them at the new percentages; that is your annual exposure.
- Update expected-payment logic so the underpayment report does not flag every post-June claim.
- Do not recode a true 78 as a 79 or 58 to avoid the reduction. That is a coding error and an audit finding.
- Thirteen other commercial policies picked up code-set updates in the same bulletin; open Add-On Codes and Maximum Frequency per Day first.
What the bulletin says
The Global Days Policy, Professional, is listed as revised with a June 1, 2026 effective date. The summary states that modifier 78 should be reported with procedure codes for treatment of postoperative complications requiring a return to the operating room, that UnitedHealthcare currently reimburses the intraoperative percentage at 84 percent of the allowed amount for procedures with a 10- or 90-day global, and that it will now reimburse at the CMS-designated intraoperative percentage, which the bulletin describes as falling anywhere between 60 and 84 percent.
The bulletin covers UnitedHealthcare commercial plans. Separate bulletins were published for Medicare Advantage, Medicaid (Community Plan) and Exchange plans; check those directly for your states, because the effective dates and the policies revised are not always identical across lines. Community Plan policies in particular depend on state contract terms and should be read state by state.
Where the percentage comes from
Every CPT code with a 10- or 90-day global period carries three percentages in the CMS RVU file: pre-operative, intra-operative and post-operative. They add to 100 and describe how CMS splits the global payment when a surgeon does only part of the package (modifiers 54, 55 and 56 use the same splits). A 90-day orthopedic procedure with a long recovery might be split 10, 69, 21. A short 10-day procedure with little follow-up might be 10, 80, 10. Modifier 78 pays the intra-operative share only.
The columns are in the national PPRRVU file that CMS publishes with each fee schedule update; most practice management systems can import it, and the Medicare Administrative Contractors' fee schedule lookup tools show the percentages by code. Ask your billing system vendor whether the global split fields are already loaded. Many systems store them but never use them, because until now most commercial payers paid a flat percentage.
A worked example
Take a general surgeon whose patient develops a post-operative hemorrhage after a laparoscopic cholecystectomy and returns to the OR for control of bleeding within the 90-day global. The return procedure is billed with modifier 78. Assume the UnitedHealthcare allowed amount for the return procedure is $1,200.
| Before June 1, 2026 | On or after June 1, 2026 | |
|---|---|---|
| Intraoperative percentage applied | 84% (flat) | CMS percentage for that code, say 69% |
| Payment on a $1,200 allowed | $1,008 | $828 |
| Difference | $180 less on this claim |
The 69 percent is illustrative; you need to look up the actual intraoperative percentage for each code you commonly bill with modifier 78. Orthopedic, general and vascular surgery groups tend to have the highest modifier 78 volume, and their post-operative percentages are often larger, which means the intraoperative share is smaller. A busy orthopedic group with 40 return-to-OR cases a year at UnitedHealthcare and an average reduction of $150 is looking at about $6,000 a year. Not ruinous, but not nothing, and it is the kind of change that quietly turns into a hundred underpayment tickets if nobody updates the expected-payment table.
Model the exposure before June 1
Pull every claim line from the past 12 months with modifier 78 and a UnitedHealthcare commercial payer. Most practices are surprised by how few there are, and a few are surprised by how many. For each CPT code on that list, look up the intraoperative percentage in the current CMS RVU file and record it next to the code. Then recalculate last year's payments at the new percentages. That is your annual exposure, and it takes an afternoon.
| Step | Output | Owner |
|---|---|---|
| Claim pull: modifier 78, UHC commercial, last 12 months | Code list with counts and paid amounts | Billing analyst |
| Look up intra-operative percentage per code | Percentage column added to the list | Coder |
| Recalculate at new percentages | Annual dollar exposure | Billing manager |
| Update expected-payment logic or document the exception | No false underpayment flags after June 1 | System administrator |
| Read other commercial contracts for flat-percentage language | List of contracts where the language now matters | Practice administrator |
The last row matters more than it looks. Several payers have already moved to code-specific intraoperative percentages; UnitedHealthcare is not the first. If a contract promises a flat percentage for modifier 78, that language is now worth something, and it is also the only basis for an appeal if a payer applies the reduction anyway. If the contract simply defers to the payer's published reimbursement policies, the policy change is the contract.
The other policies with code updates
The same bulletin lists policies that were updated for changes to industry code sets. UnitedHealthcare says these updates do not change the intent or coding requirements of the policies; they reflect new, deleted or revised CPT, HCPCS and ICD-10 codes. The commercial list includes: Add-On Codes; Assistant-at-Surgery Services; Bilateral Procedures; Co-Surgeon/Team Surgeon; Device and Skin Substitute (facility); Maximum Frequency per Day CPT; Modifier Reduction; MPPR for Medical and Surgical Services; Outpatient Hospital Maximum Frequency Per Day (facility); Preventive Medicine and Screening; Professional/Technical Component; Services and Modifiers Not Reimbursable to Health Care Professionals; and Supply Policy.
The detail is in the history section at the end of each posted policy, not in the bulletin. In our experience the ones worth opening are Add-On Codes (a code you bill as an add-on may have been removed from the eligible list) and Maximum Frequency per Day (unit limits change quietly and produce denials with CO-151 or a UnitedHealthcare-specific remark code). Assign one coder to open the three or four policies that touch your specialty and write two lines on each: what changed, and whether it affects a code you bill.
Other dates in the May overview
The May policy and protocol overview also flags an August 1, 2026 addition of select oncology medications to the Provider Administered Drugs Site of Care policy for commercial plans, a new durable medical equipment ordering process through Synapse Health starting August 1 for certain Medicare Advantage members in Alabama, Arkansas and South Carolina, and a prior authorization requirement for a colony stimulating factor medication beginning October 1, 2026. None of these change today's claims, but the oncology site-of-care change is the kind that turns into a denial three months later when nobody told the infusion scheduler.
If you want help modeling payer policy changes against your own claim history, our medical billing team does this as part of monthly reporting, and the RCM audit includes a payer policy exposure review.
Questions we hear
Does this affect modifier 79 or 58?
Not according to this bulletin. Modifier 79 (unrelated procedure in the global period) and modifier 58 (staged or related procedure) are paid differently and are not part of this revision. Keep using them correctly; do not switch a true 78 to a 79 to avoid the reduction. That is a coding error and an audit finding.
Will Medicare Advantage claims change too?
Check the Medicare Advantage bulletin for May 2026 directly. UnitedHealthcare's Medicare Advantage products generally follow CMS methodology already, so the impact there may be smaller, but do not assume.
Can we appeal claims paid at the lower percentage?
Only if your contract specifies a different methodology. Read the contract first. If it defers to the payer's published reimbursement policies, the policy change is the contract, and the appeal will be denied with a citation to the same bulletin you are reading.
What to do this month
- Download the May 2026 commercial, Medicare Advantage, Community Plan and Exchange bulletins and file them with the download date.
- Pull modifier 78 claims for the past 12 months by payer and code.
- Add the CMS intraoperative percentage to each code and calculate the annual exposure.
- Update the expected-payment table, or document the exception for payment posters, before the first June claims post in July.
- Open the Add-On Codes and Maximum Frequency per Day policies and note any code you bill that changed.
- Tell the infusion scheduler about the August 1 site-of-care change if you administer oncology drugs.
