Age-based CPT/HCPCS Coding Reimbursement
Defines UnitedHealthcare reimbursement expectations for CPT and HCPCS procedure codes that have age designations and applies to services billed on CMS-1500 (or electronic equivalent) across UnitedHealthcare Commercial and Individual Exchange benefit plans.
No material clinical or coverage changes in this revision.
Age-Based Reimbursement Criteria
Age-based reimbursement criteria
Reimbursement is contingent on the patient’s age relative to the CPT/HCPCS code’s assigned age designation.
Edits align codes to source guidance; definitive sources provide exact codes/modifiers while interpretive sources require clinical interpretation.
Age-Designated CPT/HCPCS Codes & Requirements
| See attached Age-Based-Proc-Codes- Policy-List.pdf | List of CPT and HCPCS codes with assigned age designations (attachment is not all-inclusive and is subject to change). |
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