Supply Policy, Professional - UHCprovider.comR0006).pdf · Supply Policy, Professional IMPORTANT...
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REIMBURSEMENT POLICY CMS-1500 Policy Number 2020R0006F Proprietary information of UnitedHealthcare Community Plan. Copyright 2020 United HealthCare Services, Inc. 2020R0006F Supply Policy, Professional IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission of accurate claim. 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 Community Plan reimbursement policies uses 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 Community Plan’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare Community Plan 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 Community Plan enrollees. Other factors affecting reimbursement supplement, modify or, in some cases, supersede this policy. These factors include, but are not limited to: federal &/or state regulatory requirements, the physician or other provider contracts, the enrollee’s benefit coverage documents, and/or other reimbursement, medical or drug policies. Finally, this policy may not be implemented exactly the same way on the different electronic claims processing systems used by UnitedHealthcare Community Plan due to programming or other constraints; however, UnitedHealthcare Community Plan strives to minimize these variations. UnitedHealthcare Community Plan may modify this reimbursement policy at any time by publishing a new version of the policy on this Website. However, the information presented in this policy is accurate and current as of the date of publication. *CPT Copyright American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Application This reimbursement policy applies to UnitedHealthcare Community Plan Medicaid Product. This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. With the exception of Home Health Care and Durable Medical Equipment (DME), Orthotics and Prosthetic providers billing in place of service 12, this policy applies to all products and all network and non-network physicians and other qualified health care professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals. Policy Overview This policy describes the reimbursement methodology for Healthcare Common Procedure Coding System (HCPCS) codes representing supplies, drugs and other items based on the Place of Service (POS) submitted and Centers for Medicare and Medicaid Services (CMS). The website containing the POS code set can be accessed via this link: CMS POS Code Set. This policy does not apply to Home Health Care and DME providers reporting in a place of service 12 (home). Reimbursement Guidelines Supply Reimbursement in a Physician’s or Other Qualified Healthcare Professional’s Office Certain HCPCS supply codes are not separately reimbursable as the cost of supplies is incorporated into the Evaluation and Management (E/M) service or procedure code. UnitedHealthcare Community Plan will not separately reimburse the HCPCS supply codes when those supplies are provided on the same day as an E/M service and/or procedure performed in a nonfacility place of service by a physician or other qualified health care professional.
Transcript of Supply Policy, Professional - UHCprovider.comR0006).pdf · Supply Policy, Professional IMPORTANT...
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REIMBURSEMENT POLICY CMS-1500
Policy Number 2020R0006F
Proprietary information of UnitedHealthcare Community Plan. Copyright 2020 United HealthCare Services, Inc. 2020R0006F
Supply Policy, Professional
IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission of accurate claim. 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 Community Plan reimbursement policies uses 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 Community Plan’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare Community Plan 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 Community Plan enrollees. Other factors affecting reimbursement supplement, modify or, in some cases, supersede this policy. These factors include, but are not limited to: federal &/or state regulatory requirements, the physician or other provider contracts,
the enrollee’s benefit coverage documents, and/or other reimbursement, medical or drug policies. Finally, this policy may not be implemented exactly the same way on the different electronic claims processing systems used by UnitedHealthcare Community Plan due to programming or other constraints; however, UnitedHealthcare Community Plan strives to minimize these variations. UnitedHealthcare Community Plan may modify this reimbursement policy at any time by publishing a new version of the policy on this Website. However, the information presented in this policy is accurate and current as of the date of publication. *CPT Copyright American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.
Application
This reimbursement policy applies to UnitedHealthcare Community Plan Medicaid Product. This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. With the exception of Home Health Care and Durable Medical Equipment (DME), Orthotics and Prosthetic providers billing in place of service 12, this policy applies to all products and all network and non-network physicians and other qualified health care professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals.
Policy
Overview
This policy describes the reimbursement methodology for Healthcare Common Procedure Coding System (HCPCS) codes representing supplies, drugs and other items based on the Place of Service (POS) submitted and Centers for Medicare and Medicaid Services (CMS). The website containing the POS code set can be accessed via this link: CMS POS Code Set. This policy does not apply to Home Health Care and DME providers reporting in a place of service 12 (home).
Reimbursement Guidelines
Supply Reimbursement in a Physician’s or Other Qualified Healthcare Professional’s Office
Certain HCPCS supply codes are not separately reimbursable as the cost of supplies is incorporated into the Evaluation and Management (E/M) service or procedure code. UnitedHealthcare Community Plan will not separately reimburse the HCPCS supply codes when those supplies are provided on the same day as an E/M service and/or procedure performed in a nonfacility place of service by a physician or other qualified health care professional.
https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html
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REIMBURSEMENT POLICY CMS-1500
Policy Number 2020R0006F
Proprietary information of UnitedHealthcare Community Plan. Copyright 2020 United HealthCare Services, Inc. 2020R0006F
For the purposes of this policy, a non-facility place of service is considered POS 1, 3, 4, 9, 11, 12, 13, 14, 15, 16, 17, 20, 33, 49, 50, 54, 55, 57, 60, 62, 65, 71, 72, 81 and 99.
Supply Policy Code List
Casting and Splint Supplies HCPCS codes A4570, A4580, and A4590 which were previously used for billing of splints and casts are invalid for Medicare use effective July 1, 2001, and new temporary Q codes were established to reimburse physicians and other practitioners for the supplies used in creating casts. Consistent with CMS, UnitedHealthcare Community Plan does not reimburse HCPCS codes A4570, A4580, and A4590 for casting and splint supplies. Physicians and other qualified health care professionals should the temporary Q codes (Q4001-Q4051) for reimbursement of casting and splint supplies.
Implantable Tissue Markers
CMS clarifies that implantable tissue markers (HCPCS code A4648) and implantable radiation dosimeters (HCPCS code A4650) are separately billable and payable when used in conjunction with CPT codes 19499, 32553, 49411 or 55876 on a claim for physician services. Consistent with CMS, UnitedHealthcare Community Plan will allow separate reimbursement for HCPCS codes A4648 and A4650 when billed on the same date of service with either CPT codes 19499, 32553, 49411 or 55876. If A4648 and A4650 are reported in a facility setting or without CPT codes 19499, 32553, 49411, or 55876 they are not separately reimbursable.
Reimbursement for Supplies, DME, Orthotics, Prosthetics, Biologicals, and Drugs Reported with Facility Places of Service 19, 21, 22, 23 and 24
CMS follows a Prospective Payment System (PPS) where Medicare payment is based on a predetermined, fixed amount for inpatient or outpatient facility services. With these fixed rates all costs associated with supplies, DME, orthotics, prosthetics, biologicals and drugs are deemed included in the global payment to the facility and are not considered separately reimbursable when reported on a CMS-1500 claim form by a physician or other qualified healthcare professional.
Consistent with CMS, UnitedHealthcare will not allow separate reimbursement for specific HCPCS supplies, DME, orthotics, prosthetics, biologicals, and drugs when submitted on a CMS-1500 claim form by any physician or other qualified health care professional in the following facility POS: 19, 21, 22, 23, and 24. The UnitedHealthcare Supply DME Codes in a Facility Setting and Supply Facility J-Code Denial Code list contains the codes that are not separately reimbursable in a facility place of service.
Supply Facility J-Code Denial Code List
Supply DME Codes in a Facility Setting
For the purposes of this policy, a facility place of service is considered POS 19, 21, 22, 23, and 24.
Durable Medical Equipment, Orthotics, Prosthetics, and Related Supplies Reported with Facility Places of Service 31 and 32
In alignment with the CMS PPS reimbursement methodology, UnitedHealthcare considers payment for certain DME, orthotics, prosthetics and related supply items on the CMS Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule to be included in the payment to a skilled nursing facility (POS 31) and nursing facility (POS 32) and not reimbursed separately when reported by a physician or other qualified health care professional on a CMS-1500 claim form.
Supply DME Codes in a Skilled Nursing Facility
For the purposes of this policy, skilled nursing facility and nursing facility places of service are considered POS 31 and 32.
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REIMBURSEMENT POLICY CMS-1500
Policy Number 2020R0006F
Proprietary information of UnitedHealthcare Community Plan. Copyright 2020 United HealthCare Services, Inc. 2020R0006F
Supply Code 99070
For reimbursement of covered medical and surgical supplies, an appropriate Level II HCPCS code must be submitted. The non-specific CPT code 99070 (supplies and materials, except spectacles, provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) is not reimbursable in any setting.
State Exceptions
Arizona The following lists do not apply to Arizona Medicaid: UnitedHealthcare Community Plan Supply DME codes in a Facility Setting and UnitedHealthcare Community Plan Supply DME codes in an Ambulatory Surgical Center. Arizona LTC allows codes E0194, E0304 and E0635 to be billed in POS 31 and 32
California Per State Regulations, CPT 99070 is covered when billed for unlisted supplies and materials used in non-surgical procedures and for supplies and materials provided by the physician over and above those routinely used during an office visit.
Florida Per State Regulations, Florida Medicaid allows reimbursement for HCPCs code A9900.
Hawaii The following lists do not apply to Hawaii Medicaid: UnitedHealthcare Community Plan Facility J-Codes Denial Codes, UnitedHealthcare Community Plan Supply DME codes in a Facility Setting, UnitedHealthcare Community Plan Supply DME codes in an Ambulatory Surgical Center and UnitedHealthcare Community Plan Supply DME codes in a Skilled Nursing Facility.
Kansas Per State Regulations, Kansas Medicaid allows:
• CPT code 99070 within specific parameters.
• HCPCS code J0642 in place of service 19, 22, 23.
• HCPCS codes J0220, J0221, J0257, J1050, J3060, J3385, J7030, J7040, J7042, J7050, J7070, J7100, J7110, J7120, and J7131 in place of service 19 and 22.
Massachusetts Massachusetts allows reimbursement for custom and non-custom electric wheelchairs, oxygen equipment and related supplies in a Nursing Facility POS 31 and 32 when authorized by the Health Plan.
Michigan The following lists do not apply to Michigan Medicaid: UnitedHealthcare Community Plan Supply DME codes in a Facility Setting and UnitedHealthcare Community Plan Supply DME codes in an Ambulatory Surgical Center.
Mississippi Mississippi allows codes J7303 to be billed in POS 22 for both MSCAN and MSCHIP products.
Nebraska Nebraska Medicaid utilizes their own list of codes that are not separately reimbursable in a Skilled Nursing Facility (POS 31) or Nursing Facility (POS 32). See List Here. Per State Regulations, code 99070 is reimbursable with certain considerations. Please see the C&S NE Unlisted reimbursement policy.
New Mexico The following lists do not apply to New Mexico Medicaid: UnitedHealthcare Community Plan Supply DME codes in a Facility Setting and UnitedHealthcare Community Plan Supply DME codes in an Ambulatory Surgical Center. New Mexico allows oxygen equipment and related supplies to be paid separately in a Nursing Facility POS 31 and 32. See List Here
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REIMBURSEMENT POLICY CMS-1500
Policy Number 2020R0006F
Proprietary information of UnitedHealthcare Community Plan. Copyright 2020 United HealthCare Services, Inc. 2020R0006F
Ohio Per Ohio Medicaid and MMP requirements: Contraceptive supply items A4267 and A4268 are separately reimbursable. Nursing Facility Place of Service – POS 31 and 32. The following are separately reimbursable: • Custom wheelchairs and/or custom wheelchair seating and related wheelchairs and supplies. Such items must meet State criteria and have appropriate authorization when applicable. • HCPCS E0465 and E0466
Texas Texas allows reimbursement for custom and non-custom electric wheelchairs in Nursing Facility POS 31 and 32, when authorized by the Health Plan. Texas allows codes J2182, J2786, J7175, J7179, J7202, J7207 and J7209 to be billed in POS 19 and 22.
Virginia Per State Regulations, CPT 99070 may be reimbursed:
• When billed for unlisted supplies and materials used in non-surgical procedures and for supplies and materials provided by the physician over and above those routinely used during an office visit. Documentation is required.
For Family planning supplies (such as condoms, Intrauterine Devices, etc.) when billed with the FP and U2 modifier. Invoice required.
Washington Per State Regulations, WA Medicaid allows:
• HCPCS code V2632 in a POS 24, HCPCS code J0642 in a POS 19, 21, 22, 23 & 24 and certain DME supplies to be billed in a POS 31 & 32.
Wisconsin Per State Regulations, codes A4550 and 99070 are payable within specific parameters. Wisconsin allows DME codes Q0163,Q0164,Q0166,Q0167,Q0169,Q0173,Q0174,Q0175,Q0177,Q0180, Q2004,Q2009,Q4101,Q4102,Q4103,Q4104,Q4105,Q4106,Q4107,Q4108, Q4110, Q4111, Q4112, Q4113, Q4114, Q4115, and Q4116 to be reimbursed in an Ambulatory Surgical Center. Wisconsin allows oxygen equipment and related supplies to be paid separately in a Nursing Facility POS 31 and 32. See List Here Codes E2402 and A6550 are payable in a Nursing Facility POS 31 and 32. Wisconsin state regulation considers POS 19 as non-facility place of service.
Definitions
Prospective Payment System
A Prospective Payment System (PPS) is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, diagnosis-related groups for inpatient hospital services). CMS uses separate PPSs for reimbursement to acute inpatient hospitals, home health agencies, hospice, hospital outpatient, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities.
Questions and Answers
1 Q: If a member obtains medical supplies such as blood glucose test strips or lancets from a medical supply company, what place of service should the medical supply company report?
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REIMBURSEMENT POLICY CMS-1500
Policy Number 2020R0006F
Proprietary information of UnitedHealthcare Community Plan. Copyright 2020 United HealthCare Services, Inc. 2020R0006F
A: Since the items are for home use, the medical supply company should report with a CMS Place of Service code 12 (Home). Reporting any other place of service code than 12 would be inappropriate when the items are dispensed for home use.
Attachments:
UnitedHealthcare Community Plan
NON REIMBURSABLE Supply Codes List
A List of HCPCS supply codes that are not separately reimbursable in an office, nonfacility or facility place of service.
UnitedHealthcare Community Plan Facility J-Codes Denial Codes List
A list of HCPCS drug codes not separately reimbursable in POS 19, 21, 22, 23 and 24.
UnitedHealthcare Community Plan Supply DME Codes in a Facility Setting
A list of DME codes for purchase only not separately reimbursable in POS 19, 21, 22, 23 or 24.
UnitedHealthcare Community Plan Supply DME Codes in a Skilled Nursing Facility
A list of DME, Orthotics, Prosthetics, and related supplies not separately reimbursable in POS 31 or 32.
Nebraska Non Reimbursable Supply Codes in POS 31 and 32 List
List of Supply codes not separately reimbursable for Nebraska in POS 31 and 32.
UnitedHealthcare Community Plan Oxygen Codes List
A list of Oxygen codes payable for New Mexico and Wisconsin in POS 31 and 32.
Resources
Individual state Medicaid 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
7/19/2020 Policy Version Change State Exceptions: Iowa removed Attachments section: UnitedHealthcare Community Plan Supply DME Codes in a Facility Setting
6/28/2020 Policy Version Change Attachments section: UnitedHealthcare Community Plan Facility J-Codes Denial Codes List
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UnitedHealthcare Community Plan NON REIMBURSABLE Supply Codes List
Code
A4206
A4207
A4208
A4209
A4210
A4211
A4212
A4213
A4215
A4216
A4217
A4218
A4220
A4221
A4222
A4223
A4224
A4225
A4226
A4230
A4231
A4232
A4233
A4234
A4235
A4236
A4244
A4245
A4246
A4247
A4248
A4250
A4252
A4253
A4255
A4256
A4257
A4258
A4259
A4261
A4262
A4263
A4264
A4265
-
A4266
A4267
A4268
A4269
A4270
A4280
A4281
A4282
A4283
A4284
A4285
A4286
A4290
A4300
A4301
A4305
A4306
A4310
A4311
A4312
A4313
A4314
A4315
A4316
A4320
A4321
A4322
A4326
A4327
A4328
A4330
A4331
A4332
A4333
A4334
A4335
A4336
A4337
A4338
A4340
A4344
A4346
A4349
A4351
A4352
A4353
A4354
-
A4355
A4356
A4357
A4358
A4360
A4361
A4362
A4363
A4364
A4366
A4367
A4368
A4369
A4371
A4372
A4373
A4375
A4376
A4377
A4378
A4379
A4380
A4381
A4382
A4383
A4384
A4385
A4387
A4388
A4389
A4390
A4391
A4392
A4393
A4394
A4395
A4396
A4397
A4398
A4399
A4400
A4402
A4404
A4405
A4406
A4407
A4408
-
A4409
A4410
A4411
A4412
A4413
A4414
A4415
A4416
A4417
A4418
A4419
A4420
A4421
A4422
A4423
A4424
A4425
A4426
A4427
A4428
A4429
A4430
A4431
A4432
A4433
A4434
A4435
A4450
A4452
A4455
A4456
A4458
A4459
A4461
A4463
A4465
A4467
A4470
A4480
A4481
A4483
A4490
A4495
A4500
A4510
A4520
A4550
-
A4553
A4554
A4555
A4556
A4557
A4558
A4559
A4561
A4562
A4563
A4565
A4566
A4570
A4575
A4580
A4590
A4595
A4600
A4601
A4602
A4604
A4605
A4606
A4608
A4611
A4612
A4613
A4614
A4615
A4616
A4617
A4618
A4619
A4620
A4623
A4624
A4625
A4626
A4627
A4628
A4629
A4630
A4633
A4634
A4635
A4636
A4637
-
A4638
A4639
A4640
A4649
A4651
A4652
A4653
A4657
A4660
A4663
A4670
A4671
A4672
A4673
A4674
A4680
A4690
A4706
A4707
A4708
A4709
A4714
A4719
A4720
A4721
A4722
A4723
A4724
A4725
A4726
A4728
A4730
A4736
A4737
A4740
A4750
A4755
A4760
A4765
A4766
A4770
A4771
A4772
A4773
A4774
A4802
A4860
-
A4870
A4890
A4911
A4913
A4918
A4927
A4928
A4929
A4930
A4931
A4932
A5051
A5052
A5053
A5054
A5055
A5056
A5057
A5061
A5062
A5063
A5071
A5072
A5073
A5081
A5082
A5083
A5093
A5102
A5105
A5112
A5113
A5114
A5120
A5121
A5122
A5126
A5131
A5200
A6000
A6010
A6011
A6021
A6022
A6023
A6024
A6025
-
A6154
A6196
A6197
A6198
A6199
A6203
A6204
A6205
A6206
A6207
A6208
A6209
A6210
A6211
A6212
A6213
A6214
A6215
A6216
A6217
A6218
A6219
A6220
A6221
A6222
A6223
A6224
A6228
A6229
A6230
A6231
A6232
A6233
A6234
A6235
A6236
A6237
A6238
A6239
A6240
A6241
A6242
A6243
A6244
A6245
A6246
A6247
-
A6248
A6250
A6251
A6252
A6253
A6254
A6255
A6256
A6257
A6258
A6259
A6260
A6261
A6262
A6266
A6402
A6403
A6404
A6407
A6410
A6411
A6412
A6413
A6441
A6442
A6443
A6444
A6445
A6446
A6447
A6448
A6449
A6450
A6451
A6452
A6453
A6454
A6455
A6456
A6457
A6460
A6461
A6501
A6502
A6503
A6504
A6505
-
A6506
A6507
A6508
A6509
A6510
A6511
A6512
A6513
A6530
A6531
A6532
A6533
A6534
A6535
A6536
A6537
A6538
A6539
A6540
A6541
A6544
A6545
A6549
A6550
A7000
A7001
A7002
A7003
A7004
A7005
A7006
A7007
A7008
A7009
A7010
A7012
A7013
A7014
A7015
A7016
A7017
A7018
A7020
A7025
A7026
A7027
A7028
-
A7029
A7030
A7031
A7032
A7033
A7034
A7035
A7036
A7037
A7038
A7039
A7040
A7041
A7044
A7045
A7046
A7047
A7048
A7501
A7502
A7503
A7504
A7505
A7506
A7507
A7508
A7509
A7520
A7521
A7522
A7523
A7524
A7525
A7526
A7527
A8000
A8001
A8002
A8003
A8004
A9150
A9152
A9153
A9155
A9180
A9270
A9272
-
A9273
A9274
A9275
A9276
A9277
A9278
A9279
A9280
A9281
A9282
A9283
A9284
A9285
A9286
A9300
A9900
A9901
A9999
E0235
E0325
E0326
E0570
E0572
E0574
E0575
E0580
E0585
E1500
E1575
K0743
L8047
L8510
L8617
L8618
S0516
S1015
S1030
S1031
S8120
V2520
V2755
aflore8File Attachment112619_NON REIMBURSABLE Supply Codes_20200101.pdf
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UnitedHealthcare Community Plan
Facility J-Codes Denial Codes List
J0120
J0121
J0122
J0129
J0130
J0131
J0132
J0133
J0135
J0153
J0171
J0178
J0179
J0180
J0185
J0190
J0200
J0202
J0205
J0207
J0210
J0215
J0220
J0221
J0222
J0223
J0256
J0257
J0270
J0275
J0278
J0280
J0282
J0285
J0287
J0288
J0289
J0290
J0291
J0295
J0300
J0330
J0348
J0350
-
J0360
J0364
J0365
J0380
J0390
J0395
J0400
J0401
J0456
J0461
J0470
J0475
J0476
J0480
J0485
J0490
J0500
J0515
J0517
J0520
J0558
J0561
J0565
J0567
J0570
J0571
J0572
J0573
J0574
J0575
J0583
J0584
J0585
J0586
J0587
J0588
J0591
J0592
J0593
J0594
J0595
J0596
J0597
J0598
J0599
J0600
J0604
-
J0606
J0610
J0620
J0630
J0636
J0637
J0638
J0640
J0641
J0642
J0670
J0690
J0691
J0692
J0694
J0695
J0696
J0697
J0698
J0702
J0706
J0710
J0712
J0713
J0714
J0715
J0716
J0717
J0720
J0725
J0735
J0740
J0742
J0743
J0744
J0745
J0770
J0775
J0780
J0791
J0795
J0800
J0834
J0840
J0841
J0850
J0875
-
J0878
J0881
J0882
J0883
J0884
J0885
J0887
J0888
J0890
J0894
J0895
J0896
J0897
J0945
J1000
J1020
J1030
J1040
J1050
J1071
J1094
J1095
J1096
J1097
J1100
J1110
J1120
J1130
J1160
J1162
J1165
J1170
J1180
J1190
J1200
J1201
J1205
J1212
J1230
J1240
J1245
J1250
J1260
J1265
J1267
J1270
J1290
-
J1300
J1301
J1303
J1320
J1322
J1324
J1325
J1327
J1330
J1335
J1364
J1380
J1410
J1428
J1429
J1430
J1435
J1436
J1438
J1439
J1442
J1443
J1444
J1447
J1450
J1451
J1452
J1453
J1454
J1455
J1457
J1458
J1459
J1460
J1555
J1556
J1557
J1558
J1559
J1560
J1561
J1562
J1566
J1568
J1569
J1570
J1571
-
J1572
J1573
J1575
J1580
J1595
J1599
J1600
J1602
J1610
J1620
J1626
J1627
J1628
J1630
J1631
J1640
J1642
J1644
J1645
J1650
J1652
J1655
J1670
J1675
J1700
J1710
J1720
J1726
J1729
J1730
J1740
J1741
J1742
J1743
J1744
J1745
J1746
J1750
J1756
J1786
J1790
J1800
J1810
J1815
J1817
J1826
J1830
-
J1833
J1835
J1840
J1850
J1885
J1890
J1930
J1931
J1940
J1943
J1944
J1945
J1950
J1953
J1955
J1956
J1960
J1980
J1990
J2001
J2010
J2020
J2060
J2062
J2150
J2170
J2175
J2180
J2182
J2185
J2186
J2210
J2212
J2248
J2250
J2260
J2265
J2270
J2274
J2278
J2280
J2300
J2310
J2315
J2320
J2323
J2325
-
J2326
J2350
J2353
J2354
J2355
J2357
J2358
J2360
J2370
J2400
J2405
J2407
J2410
J2425
J2426
J2430
J2440
J2460
J2469
J2501
J2502
J2503
J2504
J2505
J2507
J2510
J2513
J2515
J2540
J2543
J2545
J2547
J2550
J2560
J2562
J2590
J2597
J2650
J2670
J2675
J2680
J2690
J2700
J2704
J2710
J2720
J2724
-
J2725
J2730
J2760
J2765
J2770
J2778
J2780
J2783
J2785
J2786
J2787
J2788
J2790
J2791
J2792
J2793
J2794
J2795
J2796
J2797
J2798
J2800
J2805
J2810
J2820
J2840
J2850
J2860
J2910
J2916
J2920
J2930
J2940
J2941
J2950
J2993
J2995
J2997
J3000
J3010
J3030
J3031
J3060
J3070
J3090
J3095
J3101
-
J3105
J3110
J3111
J3121
J3145
J3230
J3240
J3243
J3245
J3246
J3250
J3260
J3262
J3265
J3280
J3285
J3300
J3301
J3302
J3303
J3304
J3305
J3310
J3315
J3316
J3320
J3350
J3355
J3357
J3358
J3360
J3364
J3365
J3370
J3380
J3385
J3396
J3397
J3398
J3399
J3400
J3410
J3411
J3415
J3420
J3430
J3465
-
J3470
J3471
J3472
J3473
J3475
J3480
J3485
J3486
J3489
J3490
J3520
J3530
J3535
J3570
J3590
J3591
J7030
J7040
J7042
J7050
J7060
J7070
J7100
J7110
J7120
J7121
J7131
J7169
J7170
J7175
J7177
J7178
J7179
J7180
J7181
J7182
J7183
J7185
J7186
J7187
J7188
J7189
J7190
J7191
J7192
J7193
J7194
-
J7195
J7196
J7197
J7198
J7199
J7200
J7201
J7202
J7203
J7204
J7205
J7207
J7208
J7209
J7210
J7211
J7303
J7304
J7308
J7309
J7310
J7311
J7312
J7313
J7314
J7315
J7316
J7318
J7320
J7321
J7322
J7323
J7324
J7325
J7326
J7327
J7328
J7329
J7330
J7331
J7332
J7333
J7336
J7340
J7342
J7345
J7401
-
J7500
J7501
J7502
J7503
J7504
J7505
J7507
J7508
J7509
J7510
J7511
J7512
J7513
J7515
J7516
J7517
J7518
J7520
J7525
J7527
J7599
J7604
J7605
J7606
J7607
J7608
J7609
J7610
J7611
J7612
J7613
J7614
J7615
J7620
J7622
J7624
J7626
J7627
J7628
J7629
J7631
J7632
J7633
J7634
J7635
J7636
J7637
-
J7638
J7639
J7640
J7641
J7642
J7643
J7644
J7645
J7647
J7648
J7649
J7650
J7657
J7658
J7659
J7660
J7665
J7667
J7668
J7669
J7670
J7674
J7676
J7677
J7680
J7681
J7682
J7683
J7684
J7685
J7686
J7699
J7799
J7999
J8498
J8499
J8501
J8510
J8515
J8520
J8521
J8530
J8540
J8560
J8562
J8565
J8597
-
J8600
J8610
J8650
J8655
J8670
J8700
J8705
J8999
J9000
J9015
J9017
J9019
J9020
J9022
J9023
J9025
J9027
J9030
J9032
J9033
J9034
J9035
J9036
J9039
J9040
J9041
J9042
J9043
J9044
J9045
J9047
J9050
J9055
J9057
J9060
J9065
J9070
J9098
J9100
J9118
J9119
J9120
J9130
J9145
J9150
J9151
J9153
-
J9155
J9160
J9165
J9171
J9173
J9175
J9176
J9177
J9178
J9179
J9181
J9185
J9190
J9198
J9200
J9201
J9202
J9203
J9204
J9205
J9206
J9207
J9208
J9209
J9210
J9211
J9212
J9213
J9214
J9215
J9216
J9217
J9218
J9219
J9225
J9226
J9228
J9229
J9230
J9245
J9246
J9250
J9260
J9261
J9262
J9263
J9264
-
J9266
J9267
J9268
J9269
J9270
J9271
J9280
J9285
J9293
J9295
J9299
J9301
J9302
J9303
J9305
J9306
J9307
J9308
J9309
J9311
J9312
J9313
J9315
J9320
J9325
J9328
J9330
J9340
J9351
J9352
J9354
J9355
J9356
J9357
J9358
J9360
J9370
J9371
J9390
J9395
J9400
J9600
J9999
aflore8File Attachment061920_C&S Facility J-Code Denial Code List_20200628.pdf
-
Supply DME Codes in a Facility Setting
Codes
A4206
A4207
A4208
A4209
A4210
A4211
A4212
A4213
A4215
A4216
A4217
A4218
A4220
A4221
A4222
A4223
A4224
A4225
A4226
A4230
A4231
A4232
A4233
A4234
A4235
A4236
A4244
A4245
A4246
A4247
A4248
A4250
A4252
A4253
A4255
A4256
A4257
A4258
A4259
A4261
A4262
A4263
A4264
A4265
-
A4266
A4267
A4268
A4269
A4270
A4280
A4281
A4282
A4283
A4284
A4285
A4286
A4290
A4300
A4301
A4305
A4306
A4310
A4311
A4312
A4313
A4314
A4315
A4316
A4320
A4321
A4322
A4326
A4327
A4328
A4330
A4331
A4332
A4333
A4334
A4335
A4336
A4337
A4338
A4340
A4344
A4346
A4349
A4351
A4352
A4353
A4354
-
A4355
A4356
A4357
A4358
A4360
A4361
A4362
A4363
A4364
A4366
A4367
A4368
A4369
A4371
A4372
A4373
A4375
A4376
A4377
A4378
A4379
A4380
A4381
A4382
A4383
A4384
A4385
A4387
A4388
A4389
A4390
A4391
A4392
A4393
A4394
A4395
A4396
A4397
A4398
A4399
A4400
A4402
A4404
A4405
A4406
A4407
A4408
-
A4409
A4410
A4411
A4412
A4413
A4414
A4415
A4416
A4417
A4418
A4419
A4420
A4421
A4422
A4423
A4424
A4425
A4426
A4427
A4428
A4429
A4430
A4431
A4432
A4433
A4434
A4435
A4450
A4452
A4455
A4456
A4458
A4459
A4461
A4463
A4465
A4467
A4470
A4480
A4481
A4483
A4490
A4495
A4500
A4510
A4520
A4550
-
A4553
A4554
A4555
A4556
A4557
A4558
A4559
A4561
A4562
A4563
A4565
A4566
A4570
A4575
A4580
A4590
A4595
A4600
A4601
A4602
A4604
A4605
A4606
A4608
A4611
A4612
A4613
A4614
A4615
A4616
A4617
A4618
A4619
A4620
A4623
A4624
A4625
A4626
A4627
A4628
A4629
A4630
A4633
A4634
A4635
A4636
A4637
-
A4638
A4639
A4640
A4649
A4651
A4652
A4653
A4657
A4660
A4663
A4670
A4671
A4672
A4673
A4674
A4680
A4690
A4706
A4707
A4708
A4709
A4714
A4719
A4720
A4721
A4722
A4723
A4724
A4725
A4726
A4728
A4730
A4736
A4737
A4740
A4750
A4755
A4760
A4765
A4766
A4770
A4771
A4772
A4773
A4774
A4802
A4860
-
A4870
A4890
A4911
A4913
A4918
A4927
A4928
A4929
A4930
A4931
A4932
A5051
A5052
A5053
A5054
A5055
A5056
A5057
A5061
A5062
A5063
A5071
A5072
A5073
A5081
A5082
A5083
A5093
A5102
A5105
A5112
A5113
A5114
A5120
A5121
A5122
A5126
A5131
A5200
A5500
A5501
A5503
A5504
A5505
A5506
A5507
A5508
-
A5510
A5512
A5513
A5514
A6000
A6010
A6011
A6021
A6022
A6023
A6024
A6025
A6154
A6196
A6197
A6198
A6199
A6203
A6204
A6205
A6206
A6207
A6208
A6209
A6210
A6211
A6212
A6213
A6214
A6215
A6216
A6217
A6218
A6219
A6220
A6221
A6222
A6223
A6224
A6228
A6229
A6230
A6231
A6232
A6233
A6234
A6235
-
A6236
A6237
A6238
A6239
A6240
A6241
A6242
A6243
A6244
A6245
A6246
A6247
A6248
A6250
A6251
A6252
A6253
A6254
A6255
A6256
A6257
A6258
A6259
A6260
A6261
A6262
A6266
A6402
A6403
A6404
A6407
A6410
A6411
A6412
A6413
A6441
A6442
A6443
A6444
A6445
A6446
A6447
A6448
A6449
A6450
A6451
A6452
-
A6453
A6454
A6455
A6456
A6457
A6460
A6461
A6501
A6502
A6503
A6504
A6505
A6506
A6507
A6508
A6509
A6510
A6511
A6512
A6513
A6530
A6531
A6532
A6533
A6534
A6535
A6536
A6537
A6538
A6539
A6540
A6541
A6544
A6545
A6549
A6550
A7000
A7001
A7002
A7003
A7004
A7005
A7006
A7007
A7008
A7009
A7010
-
A7012
A7013
A7014
A7015
A7016
A7017
A7018
A7020
A7025
A7026
A7027
A7028
A7029
A7030
A7031
A7032
A7033
A7034
A7035
A7036
A7037
A7038
A7039
A7040
A7041
A7044
A7045
A7046
A7047
A7048
A7501
A7502
A7503
A7504
A7505
A7506
A7507
A7508
A7509
A7520
A7521
A7522
A7523
A7524
A7525
A7526
A7527
-
A8000
A8001
A8002
A8003
A8004
A9150
A9152
A9153
A9155
A9180
A9270
A9272
A9273
A9274
A9275
A9276
A9277
A9278
A9279
A9280
A9281
A9282
A9283
A9284
A9285
A9286
A9300
A9900
A9901
A9999
B4034
B4035
B4036
B4081
B4082
B4083
B4087
B4088
B4100
B4102
B4103
B4104
B4105
B4149
B4150
B4152
B4153
-
B4154
B4155
B4157
B4158
B4159
B4160
B4161
B4162
B4164
B4168
B4172
B4176
B4178
B4180
B4185
B4187
B4189
B4193
B4197
B4199
B4216
B4220
B4222
B4224
B5000
B5100
B5200
B9002
B9004
B9006
B9998
B9999
E0100
E0105
E0110
E0111
E0112
E0113
E0114
E0116
E0117
E0118
E0130
E0135
E0140
E0141
E0143
-
E0144
E0147
E0148
E0149
E0153
E0154
E0155
E0156
E0157
E0158
E0159
E0160
E0161
E0162
E0163
E0165
E0167
E0168
E0170
E0171
E0172
E0175
E0181
E0182
E0184
E0185
E0186
E0187
E0188
E0189
E0190
E0191
E0193
E0194
E0196
E0197
E0198
E0199
E0200
E0202
E0203
E0205
E0210
E0215
E0217
E0218
E0221
-
E0225
E0231
E0232
E0235
E0236
E0239
E0240
E0241
E0242
E0243
E0244
E0245
E0246
E0247
E0248
E0249
E0250
E0251
E0255
E0256
E0260
E0261
E0265
E0266
E0270
E0271
E0272
E0273
E0274
E0275
E0276
E0277
E0280
E0290
E0291
E0292
E0293
E0294
E0295
E0296
E0297
E0300
E0301
E0302
E0303
E0304
E0305
-
E0310
E0315
E0316
E0325
E0326
E0328
E0329
E0350
E0352
E0370
E0371
E0372
E0373
E0424
E0425
E0430
E0431
E0433
E0434
E0435
E0439
E0440
E0441
E0442
E0443
E0444
E0445
E0446
E0447
E0455
E0457
E0459
E0462
E0465
E0466
E0467
E0470
E0471
E0472
E0480
E0481
E0482
E0483
E0484
E0485
E0486
E0487
-
E0500
E0550
E0555
E0560
E0561
E0562
E0565
E0570
E0572
E0574
E0575
E0580
E0585
E0600
E0601
E0602
E0603
E0604
E0605
E0606
E0607
E0610
E0615
E0616
E0617
E0618
E0619
E0620
E0621
E0625
E0627
E0629
E0630
E0635
E0636
E0637
E0638
E0639
E0640
E0641
E0642
E0650
E0651
E0652
E0655
E0656
E0657
-
E0660
E0665
E0666
E0667
E0668
E0669
E0670
E0671
E0672
E0673
E0675
E0676
E0691
E0692
E0693
E0694
E0700
E0705
E0710
E0720
E0730
E0731
E0740
E0744
E0745
E0746
E0747
E0748
E0749
E0755
E0760
E0761
E0762
E0764
E0765
E0766
E0769
E0770
E0776
E0779
E0780
E0781
E0782
E0783
E0784
E0785
E0786
-
E0787
E0791
E0830
E0840
E0849
E0850
E0855
E0856
E0860
E0870
E0880
E0890
E0900
E0910
E0911
E0912
E0920
E0930
E0935
E0936
E0940
E0941
E0942
E0944
E0945
E0946
E0947
E0948
E0950
E0951
E0952
E0953
E0954
E0955
E0956
E0957
E0958
E0959
E0960
E0961
E0966
E0967
E0968
E0969
E0970
E0971
E0973
-
E0974
E0978
E0980
E0981
E0982
E0983
E0984
E0985
E0986
E0988
E0990
E0992
E0994
E0995
E1002
E1003
E1004
E1005
E1006
E1007
E1008
E1009
E1010
E1011
E1012
E1014
E1015
E1016
E1017
E1018
E1020
E1028
E1029
E1030
E1031
E1035
E1036
E1037
E1038
E1039
E1050
E1060
E1070
E1083
E1084
E1085
E1086
-
E1087
E1088
E1089
E1090
E1092
E1093
E1100
E1110
E1130
E1140
E1150
E1160
E1161
E1170
E1171
E1172
E1180
E1190
E1195
E1200
E1220
E1221
E1222
E1223
E1224
E1225
E1226
E1227
E1228
E1229
E1230
E1231
E1232
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Q0515
Q1004
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Q2004
Q2009
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-
Q3028
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V2020
V2025
V2100
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V2109
V2110
V2111
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V2115
V2118
V2121
V2199
V2200
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V2209
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V2213
V2214
V2215
V2218
V2219
V2220
V2221
V2299
V2300
V2301
V2302
V2303
V2304
V2305
V2306
V2307
V2308
V2309
V2310
V2311
V2312
V2313
V2314
V2315
V2318
V2319
V2320
V2321
V2399
V2410
-
V2430
V2499
V2500
V2501
V2502
V2503
V2510
V2511
V2512
V2513
V2520
V2521
V2522
V2523
V2530
V2531
V2599
V2600
V2610
V2615
V2623
V2624
V2625
V2626
V2627
V2628
V2629
V2630
V2631
V2632
V2700
V2702
V2710
V2715
V2718
V2730
V2744
V2745
V2750
V2755
V2756
V2760
V2761
V2762
V2770
V2780
V2781
-
V2782
V2783
V2784
V2786
V2787
V2788
V2790
V2797
V2799
V5030
V5040
V5050
V5060
V5070
V5080
V5090
V5095
V5100
V5120
V5130
V5140
V5150
V5171
V5172
V5181
V5190
V5211
V5212
V5213
V5214
V5215
V5221
V5230
V5242
V5243
V5244
V5245
V5246
V5247
V5248
V5249
V5250
V5251
V5252
V5253
V5254
V5255
-
V5256
V5257
V5258
V5259
V5260
V5261
V5262
V5263
V5264
V5265
V5266
V5267
V5268
V5269
V5270
V5271
V5272
V5273
V5274
V5275
V5281
V5282
V5283
V5284
V5285
V5286
V5287
V5288
V5289
V5290
V5298
V5299
aflore8File Attachment070820_C&S Supply DME codes in a Facility Setting_20200719.pdf
-
A4233 E0105 E0261 E0600 E0791 E1010 E1355 E2324 E2611 K0601
A4234 E0110 E0265 E0601 E0840 E1011 E1372 E2325 E2612 K0602
A4235 E0111 E0266 E0602 E0849 E1012 E1390 E2326 E2613 K0603
A4236 E0112 E0271 E0605 E0850 E1014 E1391 E2327 E2614 K0604
A4253 E0113 E0272 E0606 E0855 E1015 E1392 E2328 E2615 K0605
A4602 E0114 E0275 E0607 E0856 E1016 E1405 E2329 E2616 K0606
A4604 E0116 E0276 E0610 E0860 E1017 E1406 E2330 E2619 K0607
A4605 E0117 E0277 E0615 E0870 E1018 E1700 E2340 E2620 K0608
A4608 E0130 E0280 E0617 E0880 E1020 E1800 E2341 E2621 K0730
A4614 E0135 E0290 E0618 E0890 E1028 E1801 E2342 E2622 K0733
A4618 E0140 E0291 E0619 E0900 E1029 E1802 E2343 E2623 K0738
A4619 E0141 E0292 E0620 E0910 E1030 E1805 E2351 E2624 K0800
A4624 E0143 E0293 E0621 E0911 E1031 E1806 E2359 E2625 K0801
A4628 E0144 E0294 E0627 E0912 E1035 E1810 E2360 E2626 K0802
A4630 E0147 E0295 E0629 E0920 E1036 E1811 E2361 E2627 K0806
A4633 E0148 E0296 E0630 E0930 E1037 E1812 E2362 E2628 K0807
A4635 E0149 E0297 E0635 E0935 E1038 E1815 E2363 E2629 K0808
A4636 E0153 E0300 E0636 E0940 E1039 E1816 E2364 E2630 K0813
A4637 E0154 E0301 E0639 E0941 E1050 E1818 E2365 E2631 K0814
A4638 E0155 E0302 E0640 E0942 E1060 E1820 E2366 E2632 K0815
A4639 E0156 E0303 E0650 E0944 E1070 E1821 E2367 E2633 K0816
A4640 E0157 E0304 E0651 E0945 E1083 E1825 E2368 K0001 K0820
A7000 E0158 E0305 E0652 E0946 E1084 E1830 E2369 K0002 K0821
A7001 E0159 E0310 E0655 E0947 E1087 E1831 E2370 K0003 K0822
A7002 E0160 E0316 E0656 E0948 E1088 E1840 E2371 K0004 K0823
A7003 E0161 E0325 E0657 E0950 E1092 E1841 E2372 K0005 K0824
A7004 E0162 E0326 E0660 E0951 E1093 E2000 E2373 K0006 K0825
A7005 E0163 E0371 E0665 E0952 E1100 E2100 E2374 K0007 K0826
A7006 E0165 E0372 E0666 E0953 E1110 E2101 E2375 K0009 K0827
A7007 E0167 E0373 E0667 E0954 E1150 E2120 E2376 K0010 K0828
A7008 E0168 E0424 E0668 E0955 E1160 E2201 E2377 K0011 K0829
A7009 E0170 E0431 E0669 E0956 E1161 E2202 E2378 K0012 K0835
A7010 E0171 E0433 E0670 E0957 E1170 E2203 E2381 K0015 K0836
A7012 E0175 E0434 E0671 E0958 E1171 E2204 E2382 K0017 K0837
A7013 E0181 E0439 E0672 E0959 E1172 E2205 E2383 K0018 K0838
A7014 E0182 E0441 E0673 E0960 E1180 E2206 E2384 K0019 K0839
A7015 E0184 E0442 E0675 E0961 E1190 E2207 E2385 K0020 K0840
A7016 E0185 E0443 E0691 E0966 E1195 E2208 E2386 K0037 K0841
A7017 E0186 E0444 E0692 E0967 E1200 E2209 E2387 K0038 K0842
A7020 E0187 E0447 E0693 E0968 E1221 E2210 E2388 K0039 K0843
A7025 E0188 E0462 E0694 E0969 E1222 E2211 E2389 K0040 K0848
A7026 E0189 E0465 E0705 E0971 E1223 E2212 E2390 K0041 K0849
A7027 E0191 E0466 E0720 E0973 E1224 E2213 E2391 K0042 K0850
A7028 E0193 E0467 E0730 E0974 E1225 E2214 E2392 K0043 K0851
A7029 E0194 E0470 E0731 E0978 E1226 E2215 E2394 K0044 K0852
2019B UnitedHealthcare Community Plan Supply Codes in a Skilled Nursing Facility Codes List
Page 1 of 2
-
2019B UnitedHealthcare Community Plan Supply Codes in a Skilled Nursing Facility Codes List
A7030 E0196 E0471 E0740 E0980 E1227 E2216 E2395 K0045 K0853
A7031 E0197 E0472 E0744 E0981 E1228 E2217 E2396 K0046 K0854
A7032 E0198 E0480 E0745 E0982 E1230 E2218 E2397 K0047 K0855
A7033 E0199 E0482 E0747 E0983 E1231 E2219 E2402 K0050 K0856
A7034 E0200 E0483 E0748 E0984 E1232 E2220 E2500 K0051 K0857
A7035 E0202 E0484 E0749 E0985 E1233 E2221 E2502 K0052 K0858
A7036 E0205 E0485 E0760 E0986 E1234 E2222 E2504 K0053 K0859
A7037 E0210 E0486 E0762 E0988 E1235 E2224 E2506 K0056 K0860
A7038 E0215 E0500 E0764 E0990 E1236 E2225 E2508 K0065 K0861
A7039 E0217 E0550 E0765 E0992 E1237 E2226 E2510 K0069 K0862
A7044 E0225 E0560 E0766 E0994 E1238 E2227 E2511 K0070 K0863
A7045 E0235 E0561 E0776 E0995 E1240 E2228 E2512 K0071 K0864
A7046 E0236 E0562 E0779 E1002 E1270 E2231 E2601 K0072 Q9950
A7047 E0239 E0565 E0780 E1003 E1280 E2310 E2602 K0073
A8000 E0249 E0570 E0781 E1004 E1295 E2311 E2603 K0077
A8001 E0250 E0572 E0782 E1005 E1296 E2312 E2604 K0098
A8002 E0251 E0574 E0783 E1006 E1297 E2313 E2605 K0105
A8003 E0255 E0575 E0784 E1007 E1298 E2321 E2606 K0195
A8004 E0256 E0580 E0785 E1008 E1310 E2322 E2607 K0455
E0100 E0260 E0585 E0786 E1009 E1353 E2323 E2608 K0554
Page 2 of 2
aflore8File AttachmentSupply DME Codes in a Skilled Nursing Facility.pdf
-
Nebraska Non Reimbursable
Supply Codes in POS 31 and 32
List
Codes
A4206
A4207
A4208
A4209
A4212
A4213
A4215
A4217
A4218
A4220
A4221
A4222
A4223
A4230
A4231
A4232
A4233
A4234
A4235
A4236
A4244
A4245
A4246
A4247
A4248
A4250
A4252
A4253
A4255
A4256
A4258
A4259
A4261
A4265
A4266
A4267
A4268
A4269
A4280
A4281
A4282
A4283
-
A4284
A4285
A4286
A4290
A4310
A4311
A4312
A4313
A4314
A4315
A4316
A4320
A4322
A4326
A4327
A4328
A4330
A4331
A4332
A4333
A4334
A4335
A4337
A4338
A4340
A4344
A4346
A4349
A4351
A4352
A4353
A4354
A4355
A4356
A4357
A4358
A4360
A4361
A4362
A4363
A4364
A4366
A4367
A4368
A4369
A4371
A4372
-
A4373
A4375
A4376
A4377
A4378
A4379
A4380
A4381
A4382
A4383
A4384
A4385
A4387
A4388
A4389
A4390
A4391
A4392
A4393
A4394
A4395
A4396
A4397
A4398
A4399
A4402
A4404
A4405
A4406
A4407
A4408
A4409
A4410
A4411
A4412
A4413
A4414
A4415
A4416
A4417
A4418
A4419
A4420
A4421
A4422
A4423
A4424
-
A4425
A4426
A4427
A4428
A4429
A4430
A4431
A4432
A4433
A4434
A4435
A4450
A4452
A4455
A4456
A4458
A4461
A4463
A4465
A4481
A4483
A4490
A4495
A4500
A4510
A4550
A4556
A4557
A4558
A4561
A4562
A4565
A4595
A4600
A4601
A4604
A4605
A4606
A4608
A4611
A4612
A4613
A4614
A4615
A4616
A4618
A4619
-
A4620
A4624
A4625
A4626
A4627
A4628
A4629
A4635
A4636
A4637
A4639
A4640
A4649
A4657
A4660
A4663
A4670
A4911
A4927
A4928
A4930
A4931
A4932
A5051
A5052
A5053
A5054
A5055
A5057
A5061
A5062
A5063
A5071
A5072
A5073
A5081
A5082
A5083
A5093
A5102
A5105
A5112
A5113
A5114
A5120
A5121
A5122
-
A5126
A5131
A5200
A5500
A5501
A5503
A5504
A5505
A5506
A5507
A5508
A5510
A5512
A5513
A6010
A6011
A6021
A6022
A6023
A6024
A6025
A6154
A6196
A6197
A6198
A6199
A6203
A6204
A6205
A6206
A6207
A6208
A6209
A6210
A6211
A6212
A6213
A6214
A6215
A6216
A6217
A6218
A6219
A6220
A6221
A6222
A6223
-
A6224
A6228
A6229
A6230
A6231
A6232
A6233
A6234
A6235
A6236
A6237
A6238
A6239
A6240
A6241
A6242
A6243
A6244
A6245
A6246
A6247
A6248
A6250
A6251
A6252
A6253
A6254
A6255
A6256
A6257
A6258
A6259
A6261
A6262
A6266
A6402
A6403
A6404
A6407
A6410
A6411
A6412
A6413
A6441
A6442
A6443
A6444
-
A6445
A6446
A6447
A6448
A6449
A6450
A6451
A6452
A6453
A6454
A6455
A6456
A6457
A6501
A6502
A6503
A6504
A6505
A6506
A6507
A6508
A6509
A6510
A6511
A6512
A6513
A6530
A6531
A6532
A6533
A6534
A6535
A6536
A6537
A6538
A6539
A6540
A6541
A6544
A6545
A6549
A7000
A7001
A7002
A7003
A7004
A7005
-
A7006
A7007
A7008
A7009
A7010
A7012
A7013
A7014
A7015
A7016
A7017
A7018
A7020
A7027
A7028
A7029
A7030
A7031
A7032
A7033
A7034
A7035
A7036
A7037
A7038
A7039
A7040
A7041
A7044
A7045
A7046
A7047
A7501
A7502
A7503
A7504
A7505
A7506
A7507
A7508
A7509
A7520
A7521
A7522
A7523
A7524
A7525
-
A7526
A7527
A8000
A8001
A8003
A9900
A9999
B4034
B4035
B4036
B4081
B4082
B4083
B4087
B4088
B4149
B4150
B4152
B4153
B4154
B4155
B4157
B4158
B4159
B4160
B4161
B4162
B4164
B4168
B4172
B4176
B4178
B4180
B4185
B4189
B4193
B4197
B4199
B4216
B4220
B4222
B4224
B5000
B5100
B5200
B9002
B9004
-
B9006
B9998
E0100
E0105
E0110
E0111
E0112
E0113
E0114
E0116
E0117
E0118
E0130
E0135
E0140
E0141
E0143
E0144
E0147
E0148
E0149
E0153
E0154
E0155
E0156
E0157
E0158
E0159
E0160
E0161
E0162
E0163
E0165
E0167
E0168
E0170
E0171
E0172
E0175
E0181
E0182
E0184
E0185
E0186
E0187
E0188
E0189
-
E0190
E0191
E0193
E0194
E0196
E0197
E0198
E0199
E0200
E0202
E0205
E0210
E0215
E0217
E0221
E0225
E0235
E0236
E0239
E0240
E0241
E0242
E0243
E0244
E0245
E0246
E0247
E0248
E0249
E0250
E0251
E0255
E0256
E0260
E0261
E0265
E0266
E0271
E0272
E0275
E0276
E0280
E0290
E0291
E0292
E0293
E0294
-
E0295
E0296
E0297
E0300
E0301
E0302
E0303
E0304
E0305
E0310
E0316
E0325
E0326
E0328
E0329
E0370
E0371
E0373
E0424
E0431
E0434
E0439
E0441
E0442
E0443
E0444
E0445
E0455
E0457
E0459
E0465
E0466
E0470
E0471
E0472
E0480
E0482
E0483
E0484
E0485
E0486
E0487
E0500
E0550
E0555
E0560
E0561
-
E0562
E0565
E0570
E0572
E0574
E0575
E0580
E0585
E0600
E0601
E0604
E0605
E0606
E0607
E0610
E0615
E0617
E0618
E0621
E0625
E0627
E0629
E0630
E0635
E0636
E0637
E0638
E0639
E0640
E0641
E0642
E0650
E0651
E0652
E0655
E0656
E0657
E0660
E0665
E0666
E0667
E0668
E0669
E0670
E0671
E0672
E0673
-
E0675
E0691
E0692
E0693
E0694
E0705
E0720
E0730
E0731
E0740
E0745
E0746
E0747
E0748
E0755
E0760
E0765
E0766
E0770
E0776
E0779
E0780
E0781
E0784
E0791
E0830
E0840
E0849
E0850
E0855
E0856
E0860
E0870
E0880
E0890
E0900
E0910
E0911
E0912
E0920
E0930
E0935
E0940
E0941
E0942
E0944
E0945
-
E0947
E0948
E0950
E0951
E0952
E0955
E0956
E0957
E0958
E0959
E0960
E0961
E0966
E0967
E0968
E0969
E0971
E0973
E0974
E0978
E0981
E0982
E0983
E0984
E0985
E0986
E0990
E0992
E0994
E0995
E1002
E1003
E1004
E1005
E1006
E1007
E1008
E1009
E1010
E1011
E1012
E1014
E1015
E1016
E1017
E1018
E1020
-
E1028
E1029
E1030
E1035
E1037
E1038
E1039
E1050
E1060
E1070
E1083
E1084
E1087
E1088
E1092
E1093
E1100
E1110
E1150
E1160
E1161
E1170
E1171
E1172
E1180
E1190
E1195
E1200
E1220
E1221
E1222
E1223
E1224
E1225
E1226
E1227
E1228
E1229
E1230
E1231
E1232
E1233
E1234
E1235
E1236
E1237
E1238
-
E1239
E1240
E1270
E1280
E1295
E1296
E1297
E1298
E1310
E1352
E1353
E1355
E1372
E1390
E1391
E1392
E1399
E1406
E1639
E1700
E1701
E1702
E1800
E1801
E1802
E1805
E1806
E1810
E1811
E1812
E1815
E1816
E1818
E1820
E1821
E1825
E1830
E1840
E1841
E1902
E2000
E2100
E2201
E2202
E2203
E2204
E2205
-
E2206
E2207
E2208
E2209
E2210
E2211
E2212
E2213
E2214
E2215
E2216
E2217
E2218
E2219
E2220
E2221
E2222
E2224
E2225
E2226
E2227
E2228
E2230
E2231
E2291
E2292
E2293
E2294
E2295
E2310
E2311
E2312
E2313
E2321
E2322
E2323
E2324
E2325
E2326
E2327
E2328
E2329
E2330
E2331
E2340
E2341
E2342
-
E2343
E2351
E2359
E2360
E2361
E2362
E2363
E2364
E2365
E2366
E2367
E2368
E2369
E2370
E2371
E2372
E2373
E2374
E2375
E2376
E2377
E2378
E2381
E2382
E2383
E2384
E2385
E2386
E2387
E2388
E2389
E2390
E2391
E2392
E2394
E2395
E2396
E2397
E2402
E2500
E2502
E2504
E2506
E2508
E2510
E2511
E2512
-
E2599
E2601
E2602
E2603
E2604
E2605
E2606
E2607
E2608
E2609
E2611
E2612
E2613
E2614
E2615
E2616
E2617
E2619
E2620
E2621
E2622
E2623
E2624
E2625
E8000
E8001
E8002
K0001
K0002
K0003
K0004
K0005
K0006
K0007
K0008
K0009
K0010
K0011
K0012
K0013
K0014
K0015
K0017
K0018
K0019
K0020
K0037
-
K0038
K0039
K0040
K0041
K0042
K0043
K0044
K0045
K0046
K0047
K0050
K0051
K0052
K0053
K0056
K0065
K0069
K0070
K0071
K0072
K0073
K0077
K0098
K0105
K0108
K0552
K0601
K0602
K0603
K0604
K0605
K0606
K0730
K0733
K0738
K0739
K0800
K0801
K0802
K0806
K0807
K0808
K0812
K0813
K0814
K0815
K0816
-
K0820
K0821
K0822
K0823
K0824
K0825
K0826
K0827
K0828
K0829
K0830
K0831
K0835
K0836
K0837
K0838
K0839
K0840
K0841
K0842
K0843
K0848
K0849
K0850
K0851
K0852
K0853
K0854
K0855
K0856
K0857
K0858
K0859
K0860
K0861
K0862
K0863
K0864
K0868
K0869
K0870
K0871
K0877
K0878
K0879
K0880
K0884
-
K0885
K0886
K0890
K0891
K0898
S5560
S5561
S8185
S8189
S8210
S8420
S8422
S8425
S8426
S8427
S8428
S8460
S8490
S8999
S9001
T4521
T4522
T4523
T4524
T4525
T4526
T4527
T4528
T4529
T4530
T4531
T4532
T4533
T4534
T4535
T4536
T4537
T4538
T4539
T4540
T4541
T4542
T4543
T4544
T5001
V5266
aflore8File Attachment022120_Nebraska Non Reimbursable Supply Codes in POS 31 and 32 List_20200301.pdf
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A4608 E0433 E0442 E1353 E1391 K0738
E0424 E0434 E0443 E1355 E1392
E0431 E0441 E0444 E1390 E1405
A6550 E0441 E1392 E2402
E0434 E0442 E1405
E0439 E1390 E1406
2019A UnitedHealthcare Community Plan Wisconsin Oxygen Codes List
2019A UnitedHealthcare Community Plan New Mexico Oxygen List
aflore8File AttachmentOxygen Codes List.pdf
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REIMBURSEMENT POLICY CMS-1500
Policy Number 2020R0006F
Proprietary information of UnitedHealthcare Community Plan. Copyright 2020 United HealthCare Services, Inc. 2020R0006F
3/23/2020 Policy Version Change State exceptions section: Removed reference to Louisiana
3/1/2020 Policy Version Change Attachments section: Nebraska Non Reimbursable Supply Codes in POS 31 and 32 List
1/13/2020 Policy Version Change Attachments section: UnitedHealthcare Community Plan Supply DME Codes in a Facility Setting
1/1/2020 Policy Version Change State Exceptions Section: Updated Kansas Attachments section: NON REIMBURSABLE Supply Codes List and Facility J-Codes Denial Codes List History section: Entries prior to 1/1/2018 archived
12/8/2019 Policy Version Change State Exceptions Section: Updated Washington
11/24/2019 Policy Version Change Attachments section: UnitedHealthcare Community Plan NON REIMBURSABLE Supply Codes List
11/17/2019 Policy Version Change Attachments section: UnitedHealthcare Community Plan Facility J-Codes Denial Codes List
10/6/2019 Policy Version Change Attachments section: Updated UnitedHealthcare Community Plan Facility J-Codes Denial Codes List (9/16/19) and UnitedHealthcare Community Plan Supply DME Codes in a Facility Setting (9/29/19)
9/18/2019 State Exceptions section: Updated Washington
7/7/2019- 6/30/2019
Attachments section: Updated the UnitedHealthcare Community Plan Supply DME Codes in a Facility Setting (7/7/2019), the UnitedHealthcare Community Plan NON REIMBURSABLE Supply Codes List (6/30/2019) and the UnitedHealthcare Community Plan Facility J-Codes Denial Codes List (6/30/2019)
6/16/2019 State Exceptions section: Added Washington
5/19/2019 State Exceptions section: Added Florida and updated Ohio
3/31/2019 Policy Version Change Supply Reimbursement in a Physician’s or Other Qualified Health Care Professional’s Office and Other Nonfacility Places of Service Section: Verbiage updated Definitions Section: Updated
1/13/2019 Attachments section: Updated the UnitedHealthcare Community Plan NON REIMBURSABLE Supply Codes List, UnitedHealthcare Community Plan Facility J-Codes Denial Codes List, UnitedHealthcare Community Plan Supply DME Codes in a Facility Setting, and UnitedHealthcare Community Plan Supply DME Codes in a Skilled Nursing Facility
1/1/2019 Policy Version Change Attachments section: Updated the UnitedHealthcare Community Plan NON REIMBURSABLE Supply Codes List History section: Entries prior to 1/1/2017 archived
12/9/2018 Attachments section: Updated the UnitedHealthcare Community Plan NON REIMBURSABLE Supply Codes List and description
12/2/2018 Policy Approval and Policy Version Change: Updates: Application, Overview, Supply Reimbursement in a Physician’s or Other Qualified Health Care Professional’s Office and Other Nonfacility Places of Service, Casting and Splint
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REIMBURSEMENT POLICY CMS-1500
Policy Number 2020R0006F
Proprietary information of UnitedHealthcare Community Plan. Copyright 2020 United HealthCare Services, Inc. 2020R0006F
Supplies, Reimbursement for Supplies, Purchased Durable Medical Equipment (DME), Orthotics, Prosthetics, Biologicals, and Drugs submitted with a J Code Reported with Facility Places of Service 19, 21, 22, 23 and 24, Definitions and Q&A sections Removed: Bundling HCPCS Code L8680 with CPT Code 63650 section Attachments section: Updated the UnitedHealthcare Community Plan NON REIMBURSABLE
