Within the code description, Current Procedural Terminology (CPT®) book parentheticals and coding guidance by the American Medical Association (AMA) or Centers for Medicare and Medicaid Services (CMS) in other publications, certain CPT and Healthcare Common Procedure Coding System (HCPCS) Level II codes specify a time parameter for which the code should be reported (e.g., weekly, monthly). This policy describes reimbursement for these Time Span Codes.
For the purposes of this policy, the same physician or other qualified health care professional includes all physicians and/or other qualified health care professionals of the same group with the same federal tax identification number.
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Q: How does UnitedHealthcare determine the “time span” for codes with a description of calendar month, per month or monthly?
A: UnitedHealthcare determines the “time span” for codes with a description of Calendar Month, per month or monthly by an individually named month of the year, e.g., January, February etc. Reimbursement is only allowed once per that individual month. If a code description says 30 or 31 days, then 30 or 31 days must pass since the last submission before reimbursement is allowed again.
Q: Does UnitedHealthcare recognize modifiers, e.g., 59, 76, through the Time Span Codes Policy to allow reimbursement for additional submissions of a code within the designated time span?
A: No. Reimbursement for codes included in the Time Span Codes Policy is based on the time span parameter specified in the code description, CPT book parentheticals and/or other coding guidance from the AMA or CMS.