Care Plan Oversight Policy - Reimbursement Policy - UnitedHealthcare Community Plan

Overview

Care Plan Oversight (CPO) Services refer to physician and other health care professional supervision of patients under the care of home health agencies, hospice, or nursing facilities. Care Plan Oversight services are reported separately

from codes for office/outpatient, hospital, home, nursing facility, or domiciliary services. Code selection for Care Plan Oversight Services is determined by the complexity and approximate time spent by the physician or other health care professional within a 30 - day period.

Reimbursement Guidelines

UnitedHealthcare Community Plan considers Care Plan Oversight Services to be reimbursable services when submitted with the following codes only:

  • CPT codes: 94005, 99340, 99375, 99378, 99380, 0405T
  • HCPCS codes: G0086, G0087, G0179, G0180, G0181, G0182, G2014, G2015

CPO services are reimbursed for 30 minutes or more per Centers for Medicare & Medicaid Services (CMS) guidelines. The following codes are not reimbursable for Care Plan Oversight Services:

  • CPT codes: 99339, 99374, 99377, 99379
  • HCPCS codes: S0220, S0221, S0250, S0270, S0271, S0272

Policy Codes

Find your specific codes below.

This policy contains more codes than can be displayed on one screen. Find your specific code below.

Enter your code here As you input 2 or more characters, a clear button becomes available, and codes will dynamically display below. The number of returned codes will decrease as you enter more characters.

Questions and Answers

Q: Does UnitedHealthcare Community Plan reimburse Care Plan Oversight Services codes for less than 30 minutes?

A: UnitedHealthcare Community Plan follows CMS payment methodology for reimbursement of Care Plan Oversight Services. According to the CMS Medicare Benefit Policy Manual, Covered Medical and Other Health Services, Chapter 15, Section 30, these services are covered only if the physician furnished at least 30 minutes of Care Plan Oversight within the calendar month for which payment is claimed

* UHCCP-Care-Plan-Oversight-Policy-(R0033).pdf
Medicaid Reimbursement - Care Plan Oversight Policy

Resources

Individual state Medicaid contracts, regulations, manuals & fee schedules

American Medical Association , Current Procedural Terminology ( CPT®) and associated publications and services

Centers for Medicare and Medicaid Services, CMS Manual System and other CMS publications and services Centers for Medicare and Medicaid Services, Healthcare Common Procedure Coding System, HCPCS Release and Code Sets

History

  • 6/7/2019 Annual Anniversary Date and Version Change
  • 3/31/2019 Policy Version Change  Title section: Removed Annual Approval information & moved policy # to the header Policy Update: CPO Eligible Codes list updated
  • 1/1/2019 Policy Version Change Policy Update: “Professional” added to title, preamble updated, Reimbursement section updated; Codes table removed; Care Plan Oversight Eligible Codes list added. History prior to 1/1/2017 archived 
  • 9/15/2018 Application section update per legal update 
  • 6/17/2018 Annual Policy Version Change State Exception Section: Exception added for Virginia History prior to 1/1/2016 archived.
  • 7/15/2017 Application Section: Removed UnitedHealthcare Community Plan Medicare products as applying to this policy. Added location for UnitedHealthcare Community Plan Medicare reimbursement policies.
  • 1/1/2017 Annual Policy Version Change History prior to 1/1/2015 archived.
  • 1/30/2006 Policy implemented by UnitedHealthcare Community & State