UnitedHealthcare Medicare Advantage Reimbursement Policies
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01/01/2024 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: January 2024open_in_new
Last Published 01.01.2024
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01/01/2025 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: January 2025open_in_new
Last Published 01.01.2025
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02/01/2024 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: February 2024open_in_new
Last Published 02.01.2024
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02/01/2025 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: February 2025open_in_new
Last Published 02.01.2025
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03/01/2024 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: March 2024open_in_new
Last Published 03.01.2024
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04/01/2023 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: April 2023open_in_new
Last Published 05.24.2023
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04/01/2024 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: April 2024open_in_new
Last Published 04.01.2024
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05/01/2023 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: May 2023open_in_new
Last Published 05.24.2023
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05/01/2024 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: May 2024open_in_new
Last Published 05.01.2024
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07/01/2023 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: July 2023open_in_new
Last Published 07.01.2023
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07/01/2024 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: July 2024open_in_new
Last Published 07.01.2024
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08/01/2023 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: August 2023open_in_new
Last Published 08.17.2023
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08/01/2024 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: August 2024open_in_new
Last Published 09.06.2024
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09/01/2024 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: September 2024open_in_new
Last Published 09.01.2024
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10/01/2024 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: October 2024open_in_new
Last Published 10.08.2024
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10/1/2023 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: October 2023open_in_new
Last Published 10.01.2023
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11/01/2024 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: November 2024open_in_new
Last Published 11.01.2024
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11/1/2023 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: November 2023open_in_new
Last Published 11.01.2023
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12/01/2024 – UnitedHealthcare Medicare Advantage Reimbursement Policy Update Bulletin: December 2024open_in_new
Last Published 12.01.2024
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Add-on Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 01.08.2025
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Anatomical Modifier Requirement Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 01.24.2025
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Anesthesia Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 02.01.2025
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Assistant-at-Surgery Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 08.27.2024
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Bilateral Procedures Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantage Plansopen_in_new
Last Published 06.01.2024
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Clinical Laboratory Improvement Amendments (CLIA) ID Requirement - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 04.01.2024
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Co-Surgeon/Team Surgeon Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 05.20.2024
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Diagnosis Code Requirement Policy, Professional and Facility - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 02.03.2025
R9064, -
Discarded Drugs and Biologicals, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantage Plansopen_in_new
Last Published 02.01.2025
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Drug Testing Policy - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 05.01.2024
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Durable Medical Equipment Charges in a Skilled Nursing Facility Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantage Plansopen_in_new
Last Published 03.01.2024
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Durable Medical Equipment, Orthotics and Prosthetics Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantage Planopen_in_new
Last Published 05.01.2023
R9012, 2023R9012A, 2023R9012, -
Emergency Department (ED) Facility Evaluation and Management (E&M) Coding Policy - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 01.01.2025
Hospital Acquired Conditions Policy, Facility, -
Evaluation and Management (E/M) Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 04.01.2024
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From – To Date Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantage Plansopen_in_new
Last Published 02.01.2024
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Global Days Policy, Professional - UnitedHealthcare Medicare Advantage Reimbursement Policyopen_in_new
Last Published 04.01.2024
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Home Health Services Policy, Professional and Facility - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 12.20.2024
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Hospital Acquired Conditions Policy, Facility - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 10.18.2024
Hospital Acquired Conditions Policy, Facility, -
Hospital Inclusive Charges Policy, Facility - UnitedHealthcare Medicare Advantage Reimbursement Policyopen_in_new
Last Published 11.22.2024
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Incident To Services, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 03.01.2024
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Increased Procedural Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 12.26.2024
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Intensity Modulated Radiation Therapy (IMRT) Policy, Professional and Facility- Reimbursement Policy - UnitedHealthcare Medicare Advantage Plansopen_in_new
Last Published 02.01.2025
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Intraoperative Neuromonitoring Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 02.01.2025
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Laboratory Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 06.01.2024
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Medically Unlikely Edits (MUE) Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantage Plansopen_in_new
Last Published 01.31.2025
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Medicare Physician Fee Schedule Status Indicator, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 12.26.2024
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Modifier Reference Policy, Professional Professional - UnitedHealthcare Medicare Advantage Reimbursement Policyopen_in_new
Last Published 12.20.2024
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Modifiers Not Reimbursable to Healthcare Professionals Policy, Professional - UnitedHealthcare Medicare Advantage Reimbursement Policyopen_in_new
Last Published 12.01.2024
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Mohs Micrographic Surgery Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 05.01.2024
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Molecular Pathology Policy, Professional and Facility - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 06.01.2024
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Multiple Procedure Payment Reduction (MPPR) for Diagnostic Imaging Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 05.01.2024
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Multiple Procedure Payment Reduction (MPPR) for Medical and Surgical Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantage Plansopen_in_new
Last Published 04.01.2024
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Multiple Procedure Payment Reduction (MPPR) for Therapy Services, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 03.01.2024
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National Drug Code (NDC) Requirement Professional and Facility Policy - UnitedHealthcare Medicare Advantage Reimbursement Policyopen_in_new
Last Published 09.18.2024
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New Patient Visit Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantage open_in_new
Last Published 01.01.2025
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Non-Chemotherapy Injection and Infusion Services, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantage Plansopen_in_new
Last Published 01.23.2025
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Nonphysician Health Care Professionals Billing Evaluation and Management, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 10.01.2024
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Observation and Discharge Policy, Professional and Facility - Reimbursement Policy - UnitedHealthcare Medicare Advantage Plansopen_in_new
Last Published 02.01.2025
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Once in a Lifetime Procedures, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 03.01.2024
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Procedure and Place of Service, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 01.10.2025
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Procedure to Modifier Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 08.12.2024
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Professional/Technical Component, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 01.26.2025
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Radiation Therapy Planning, Dosimetry, Simulation/Devices and Management Policy, Professional and Facility - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 02.05.2025
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Rebundling and NCCI Edits, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 02.01.2025
According to the Centers for Medicare and Medicaid Services (CMS), medical and surgical procedures should be reported with the Current Procedural Terminology (CPT®) or Healthcare Common Procedure Coding System (HCPCS) codes that most comprehensively describe the services performed. UnitedHealthcare Medicare Advantage uses this policy to determine whether CPT and/or HCPCS codes reported together by the Same Individual Physician or Other Qualified Health Care Professional for the same member on the same date of service are eligible for separate reimbursement., -
Reduced Services and Discontinued Procedures Policy, Professional and Facility - Reimbursement Policy - UnitedHealthcare Community Planopen_in_new
Last Published 11.01.2024
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Same Day, Same Service Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 04.01.2024
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Services by Residents, Interns and Medical Students Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantage.open_in_new
Last Published 08.27.2024
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Services Included in Facility Reimbursement Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantage Plansopen_in_new
Last Published 05.01.2024
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Split Surgical Package Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 05.26.2023
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Standby Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 07.01.2024
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Supply Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantage Plansopen_in_new
Last Published 08.28.2024
UnitedHealthcare Medicare, -
Telehealth and Telemedicine Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 03.19.2024
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Time Span Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Medicare Advantageopen_in_new
Last Published 01.01.2025
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For questions, please contact your local Network Management representative or call the Provider Services number on the back of the member’s health ID card.
Medicare Advantage Reimbursement Policies Terms and Conditions
Please read the terms and conditions below carefully.
The UnitedHealthcare Medicare Advantage Reimbursement Policies ("Reimbursement Policies") are applicable to UnitedHealthcare Medicare Advantage Plans offered by UnitedHealthcare and its affiliates.
You are responsible for submission of accurate claims. The Reimbursement Policies are intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. The Reimbursement Policies use Current Procedural Terminology (CPT®*), Centers for Medicare and Medicaid Services (CMS), or other coding guidelines. References to CPT® or other sources are for definitional purposes only and do not imply any right to reimbursement.
The Reimbursement Policies apply to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms (CMS 1450). Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing Reimbursement Policies.
Reimbursement Policies are intended to serve only as a general resource for the services described and are not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare may use reasonable discretion in interpreting and applying the Reimbursement Policies to health care services provided in a particular case. Further, the Reimbursement Policies do not address all issues related to reimbursement for health care services provided to UnitedHealthcare members. Other factors affecting reimbursement may supplement, modify or, in some cases, supersede the Reimbursement Policies. These factors may include, but are not limited to: legislative mandates, the physician or other provider contracts, and/or the member specific benefit plan documents**. Finally, the Reimbursement Policies may not be implemented exactly the same way on the different electronic claims processing systems used by UnitedHealthcare due to programming or other constraints; however, UnitedHealthcare strives to minimize these variations.
UnitedHealthcare may modify Reimbursement Policies at any time by publishing a new version of the Reimbursement Policies on this website. However, the information presented in the Reimbursement Policies is accurate and current as of the date of their publication. UnitedHealthcare regularly updates its Reimbursement Policies to comply with changes in CMS policy and other standard coding guidelines. UnitedHealthcare encourages physicians and other healthcare professionals to keep current with any CMS policy changes and/or billing requirements by referring to the CMS or your local carrier website regularly. Physicians and other healthcare professionals can sign up for regular distributions for policy or regulatory changes directly from CMS and/or your local carrier. UnitedHealthcare Reimbursement Policies do not include notations regarding prior authorization requirements. View services requiring prior authorization. Unauthorized copying, use and distribution of this information are strictly prohibited.
*CPT® is a registered trademark of the American Medical Association.
** For more information on a specific member's benefit coverage, please call the customer service number on the back of the member ID card or refer to the Administrative Guide.
By clicking "I Agree," you agree to be bound by the terms and conditions expressed herein, in addition to our Site Use Agreement.