You are responsible for submission of accurate claims. This reimbursement policy is intended to ensure
that you are reimbursed based on the code or codes that correctly describe the health care services
provided. UnitedHealthcare reimbursement policies may 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.
This reimbursement policy applies to all health care services billed on CMS 1500 forms and, when
specified, to those billed on UB04 forms. 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’s
reimbursement policy for the services described and is not intended to address every aspect of a
reimbursement situation. Accordingly, UnitedHealthcare may use reasonable discretion in interpreting
and applying this policy to health care services provided in a particular case. Further, the policy does not
address all issues related to reimbursement for health care services provided to UnitedHealthcare
enrollees. Other factors affecting reimbursement may supplement, modify or, in some cases, supersede
this policy. These factors may include, but are not limited to: legislative mandates, the physician or other
provider contracts, the enrollee’s benefit coverage documents and/or other reimbursement, medical or
drug policies.
