Community Plan Reimbursement Policies of New York
For policies listed below that do not apply to UnitedHealthcare Community Plan Medicare products, as indicated in the Application section of each policy, please refer to the UnitedHealthcare Medicare Advantage Reimbursement Policies for further information.
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Current Policies
Community Plan Reimbursement Policies Terms and Conditions
Please read the terms and conditions below carefully.
Important Note about Reimbursement Polices
All provider notification regarding UnitedHealthcare Community Plan reimbursement and medical policies will be posted on this website.
The UnitedHealthcare Community Plan Reimbursement policies are generally based on national reimbursement determinations, along with state government program reimbursement policies and requirements. Please note that where a specific conflict between a provision of a contract between UnitedHealthcare Community Plan and an applicable state program a provider contracts or state/federal regulations, such contract/regulation will supersede these reimbursement policies.
Important Policy Note
You are responsible for submission of accurate claims requests. This reimbursement policy is intended to ensure that you are reimbursed based on the code that correctly describes the procedure performed. This and other UnitedHealthcare Community Plan reimbursement policies may use CPT, CMS or other coding methodologies from time to time. References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement. This reimbursement policy applies to all professionals who deliver health care services. Coding methodology, industry standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy.
This information is intended to serve only as a general reference resource regarding UnitedHealthcare Community Plan’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare Community Plan may use reasonable discretion interpreting and applying this policy to services being delivered in a particular case. Further, the policy does not cover all issues related to reimbursement for services rendered to UnitedHealthcare Community Plan enrollees as legislative mandates, the physician or other provider contract documents, the enrollee’s benefit coverage documents, and the Physician Manual all may supplement or, in some cases, supercede this policy. Finally, this policy may not be implemented in exactly the same way on the different electronic claim processing systems used by UnitedHealthcare Community Plan due to programming or other constraints; however, UnitedHealthcare Community Plan strives to minimize these variations.
UnitedHealthcare Community Plan may modify this reimbursement policy from time to time by publishing a new version of the policy on this website; however, the information presented in this policy is believed to be accurate and current as of the date of publication.
By clicking "I Agree," you agree that you have read and understood the UnitedHealthcare Community Plan reimbursement policy.
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01/01/2025 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: January 2025
Last Published 01.01.2025
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02/01/2025 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: February 2025
Last Published 02.01.2025
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05/01/2023 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: May 2023
Last Published 08.18.2023
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06/01/2023 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: June 2023
Last Published 08.18.2023
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07/01/2023 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: July 2023
Last Published 08.18.2023
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08/01/2023 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: August 2023
Last Published 08.24.2023
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09/01/2023 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: September 2023
Last Published 09.01.2023
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1/01/2024 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: January 2024
Last Published 01.01.2024
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10/01/2024 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: October 2024
Last Published 10.01.2024
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11/01/2023 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: November 2023
Last Published 11.01.2023
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11/01/2024 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: November 2024
Last Published 11.01.2024
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12/01/2023 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: December 2023
Last Published 12.01.2023
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12/01/2024 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: December 2024
Last Published 01.16.2025
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2/01/2024 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: February 2024
Last Published 02.01.2024
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3/01/2024 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: March 2024
Last Published 03.01.2024
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4/01/2023 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: April 2023
Last Published 08.18.2023
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4/01/2024 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: April 2024
Last Published 04.01.2024
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5/01/2024 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: May 2024
Last Published 05.24.2024
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6/01/2024 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: June 2024
Last Published 07.26.2024
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7/01/2024 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: July 2024
Last Published 09.26.2024
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8/01/2024 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: August 2024
Last Published 08.01.2024
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9/01/2024 – UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: September 2024
Last Published 09.26.2024
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Add-On Codes Policy, Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.26.2025
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Add-on Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.19.2025
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Adjunct Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.15.2025
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After Hours and Weekend Care Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 09.24.2023
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Age to Diagnosis Code and Procedure Code - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.18.2025
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Ambulance Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.21.2025
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Anatomical Modifier Requirement Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 10.01.2024
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Anesthesia Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 12.31.2024
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Appropriate Patient Discharge Status for Type of Bill Policy, Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 08.01.2023
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Assistant at Surgery Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.23.2025
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Audiologic Vestibular Function Testing Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 07.17.2024
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B Bundle Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.15.2025
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Bilateral Procedures Policy, Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.24.2025
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Bilateral Procedures Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.24.2025
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Care Plan Oversight Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.03.2025
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CCI Editing Policy, Professional and Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.03.2025
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Cesarean Delivery Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 06.19.2024
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Clinical Diagnostic Lab Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 11.25.2024
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Clinical Laboratory Improvement Amendments (CLIA) ID Requirement Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 11.18.2024
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Co-Surgeon / Team Surgeon Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 12.20.2024
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Consultation Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 10.13.2024
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Contrast and Radiopharmaceutical Materials Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.01.2025
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Device and Skin Substitute Policy, Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.13.2025
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Diabetic and Other Orthopedic Shoes Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 12.12.2024
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Diagnosis Code Requirement Policy, Professional and Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 11.03.2024
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Discarded Drugs and Biologicals Policy, Professional and Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.28.2025
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Discontinued Procedure Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.07.2024
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Drug Testing Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.24.2025
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Durable Medical Equipment Orthotics and Prosthetics Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.04.2025
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Emergency Department (ED) Facility Evaluation and Management (E&M) Coding Policy - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.10.2025
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Emergency Room Ancillary Services Policy, Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 07.05.2024
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Evaluation and Management (E/M) Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.28.2024
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Facility Billing Policy, Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 05.24.2024
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From-To Date Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.01.2025
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Global Days Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.04.2025
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Home Health Services Policy Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.14.2025
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Hospital Inclusive Charges Policy, Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 12.02.2024
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Incontinence Supplies Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 12.31.2024
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Increased Procedural Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 04.16.2024
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Injection and Infusion Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.01.2025
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Injections into Tendon Sheath, Ligament, Ganglion Cyst, Carpal and Tarsal Tunnel Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 06.24.2024
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Intraoperative Neuromonitoring Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.03.2024
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Laboratory Services Policy, Professional-Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.01.2025
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Maximum Frequency Per Day Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.24.2025
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Medically Unlikely Edits Policy Professional and Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.10.2025
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Microsurgery Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.02.2024
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Modifier Policy, Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.25.2024
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Modifier Reference Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.07.2025
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Modifier SU Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 04.07.2023
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Mohs Micrographic Surgery Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 07.31.2023
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Molecular Pathology Policy, Professional and Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.01.2025
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Multiple Procedure Payment Reduction (MPPR) for Diagnostic Cardiovascular and Ophthalmology Procedures Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 12.30.2023
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Multiple Procedure Payment Reduction (MPPR) for Diagnostic Imaging Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.01.2024
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Multiple Procedure Payment Reduction (MPPR) for Medical and Surgical Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.16.2025
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National Drug Code (NDC) Requirement Policy, Professional and Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 08.13.2024
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New Patient Visit Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.16.2025
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Non Covered and Covered Codes Policy, Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.23.2025
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Non Covered and Covered Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.19.2025
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Nonphysician Health Care Professionals Billing Evaluation and Management Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.16.2025
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Observation and Discharge Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.17.2024
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Observation Services Policy, Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.10.2025
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Obstetrical Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 12.24.2024
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Obstetrical Ultrasound Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 08.09.2024
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Once in a Lifetime Procedures Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.25.2024
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One or More Sessions Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 03.11.2024
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Orthotics (L3000) Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 06.28.2024
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Otoacoustic Emissions Testing Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 09.04.2024
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Outpatient Medical Visits and Trauma Activation Policy, Facility - UnitedHealthcare Community Plan
Last Published 06.07.2024
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Outpatient Rehabilitation Therapy Service Policy, Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.15.2024
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Pediatric and Neonatal Critical and Intensive Care Services Policy - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 06.21.2024
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Physical Medicine & Rehabilitation: Multiple Therapy Procedure Reduction Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.13.2025
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Physical Medicine & Rehabilitation: PT, OT and Evaluation & Management Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 07.30.2024
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Physical Medicine & Rehabilitation: Speech Therapy Policy - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 12.30.2024
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Preventive Medicine and Screening Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.09.2025
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Procedure to Modifier Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.19.2025
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Procedure to Place of Service Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.25.2025
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Professional/Technical Component Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.16.2025
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Prolonged Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 07.23.2024
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Provider Preventable Conditions: Health Care Acquired Conditions and Present on Admission Policy, Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.02.2024
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Radiation Therapy Planning, Dosimetry, Simulation/Devices and Management Policy, Professional and Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.06.2025
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Radioallergosorbent (RAST) Type Tests Policy, Professional Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 06.21.2024
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Readmission Policy, Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.05.2025
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Rebundling Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 09.03.2024
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Reduced Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.09.2024
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Replacement Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 12.11.2024
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Respiratory Viral Panel Testing Policy, Professional and Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.22.2025
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Revenue Codes Requiring Procedure Code Policy, Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.09.2025
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Robotic Assisted Surgery Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 06.21.2024
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Same Day/Same Service Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.31.2025
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Services and Modifiers Not Reimbursable to Healthcare Professionals Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.23.2025
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Services by Residents, Interns and Medical Students Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 09.03.2024
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Sexually Transmitted Infection Testing Policy, Professional and Facility - Reimbursement Policy - UnitedHealthcare Community Pla
Last Published 12.30.2024
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Split Surgical Package Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.12.2025
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Supply Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 02.07.2025
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T Status Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.02.2024
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Time Span Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.06.2025
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UHCCP-Telehealth-Virtual-Health-Policy-Professional-and-Facility-R7133
Last Published 02.23.2025
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Unlisted Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.12.2025
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Vaccines for Children Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 12.31.2024
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Vitamin D Testing Policy, Professional - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 01.23.2024
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Wrong Surgical or Other Invasive Procedures Policy, Professional and Facility - Reimbursement Policy - UnitedHealthcare Community Plan
Last Published 03.15.2024