Procedure and Place of Service Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans

Overview

The Procedure and Place of Service policy addresses the reimbursement of Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes that are reported in a place of service (POS) considered inappropriate based on the code’s description or available coding guidelines when reported by a physician or other health care professional.

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.

  • 94002
  • 94003
  • 94004
  • 99155
  • 99156
  • 99157
  • 99201
  • 99202
  • 99203
  • 99204
  • 99205
  • 99211
  • 99212
  • 99213
  • 99214
  • 99215
  • 99217
  • 99218
  • 99219
  • 99220
  • 99221
  • 99222
  • 99223
  • 99224
  • 99225
  • 99226
  • 99231
  • 99232
  • 99233
  • 99234
  • 99235
  • 99236
  • 99238
  • 99239
  • 99241
  • 99242
  • 99243
  • 99244
  • 99245
  • 99251
  • 99252
  • 99253
  • 99254
  • 99255
  • 99281
  • 99282
  • 99283
  • 99284
  • 99285
  • 99304
  • 99305
  • 99306
  • 99307
  • 99308
  • 99309
  • 99310
  • 99315
  • 99316
  • 99318
  • 99324
  • 99325
  • 99326
  • 99327
  • 99328
  • 99334
  • 99335
  • 99336
  • 99337
  • 99341
  • 99342
  • 99343
  • 99344
  • 99345
  • 99347
  • 99348
  • 99349
  • 99350
  • 99460
  • 99461
  • 99462
  • 99463
  • 99465
  • 99466
  • 99468
  • 99469
  • 99471
  • 99472
  • 99475
  • 99476
  • 99477
  • 99478
  • 99479
  • 99480
  • 99483
  • 99500
  • 99501
  • 99502
  • 99503
  • 99504
  • 99505
  • 99506
  • 99507
  • 99509
  • 99510
  • 99511
  • 99512
  • 99600
  • 99601
  • 99602
  • G0076
  • G0077
  • G0078
  • G0079
  • G0080
  • G0081
  • G0082
  • G0083
  • G0084
  • G0085
  • G0128
  • G0151
  • G0152
  • G0153
  • G0155
  • G0156
  • G0157
  • G0158
  • G0159
  • G0160
  • G0161
  • G0162
  • G0257
  • G0299
  • G0300
  • G0398
  • G0399
  • G0400
  • G0490
  • G0493
  • G0494
  • G0495
  • G0496
  • G0511
  • G0512
  • G2001
  • G2002
  • G2003
  • G2004
  • G2005
  • G2006
  • G2007
  • G2008
  • G2009
  • G2013
  • G2067
  • G2068
  • G2069
  • G2070
  • G2071
  • G2072
  • G2073
  • G2074
  • G2075
  • G2076
  • G2077
  • G2078
  • G2079
  • G2080
  • G2082
  • G2083
  • G9147
  • G9490
  • G9685
  • Q5001
  • Q5002
  • Q5003
  • Q5004
  • Q5005
  • Q5006
  • Q5007
  • Q5010
  • S0260
  • S0273
  • S0274
  • S5108
  • S5109
  • S5110
  • S5111
  • S5115
  • S5116
  • S5180
  • S9097
  • S9098
  • S9122
  • S9123
  • S9124
  • S9125
  • S9126
  • S9127
  • S9128
  • S9129
  • S9131
  • S9208
  • S9209
  • S9211
  • S9212
  • S9213
  • S9214
  • S9335
  • S9339
  • S9590
  • T1015
  • T1021
  • T1022
  • T1025
  • T1026
  • T1028
  • T1030
  • T1031
  • T2042
  • T2043
  • T2044
  • T2045
  • T2046
* COMM-Procedure-and-Place-of-Service-Policy.pdf
Click to Download: Procedure and Place of Service Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans

Questions and Answers

Q: Why aren’t all CPT and HCPCS codes addressed in this policy?

A: This policy addresses CPT and HCPCS codes that include a place of service (POS) in their description or in their coding guidelines and CPT and HCPCS codes assigned the Non-Facility Indicator “NA”. Codes that do not fit these criteria, as well as mental health/substance abuse codes and codes addressed in other reimbursement policies, are out of scope for this reimbursement policy

Q: Where do the Place of Service codes come from?

A: The Place of Service codes can be found on the CMS website and contains two-digit codes placed on health care professional claims to indicate the setting in which a service was provided. The Centers for Medicare & Medicaid Services (CMS) maintains POS codes us ed throughout the health care industry.