CurrentColorado Rocky Mountain Health PlansPolicy 2026R0033A

Care Plan Oversight (CPO) reimbursement

Defines UnitedHealthcare reimbursement policy for Care Plan Oversight services billed on the CMS-1500 form (and electronic equivalent) for commercial and individual exchange plans, and for all network and non-network physicians and qualified health care professionals.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyCare Plan Oversight (CPO) reimbursement

Policy CodePolicy 2026R0033A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionSubmit claims on CMS-1500 (or electronic equivalent); CPO is reimbursable only when at least 30 minutes of oversight is furnished in the calendar month.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

30 minminimum time per 30-day period required for CPO reimbursement

11 codesnumbered code mappings shown in policy

9 codescodes specifically excluded from reimbursement

Commercial & Exchangeplan types governed

Care Plan Oversight Coverage Criteria

Care Plan Oversight coverage criteria

Covered when ALL of the following are met:

Care Plan Oversight (CPO) services are reimbursable only when billed with an eligible CPO code listed in this policy and when the minimum time requirement is met.

ALL of the following

Eligible CPO codes (ONE of):
- 99375
- 99378
- 99380
- G0086
- G0087
- G0179
- G0180
- G0181
- G0182
- G2014
- G2015
Code selection should be determined by the complexity of oversight and approximate time within the 30-day (calendar month) period.

ALL of the following

Minimum time: At least 30 minutes of Care Plan Oversight must be furnished within the calendar month for which payment is claimed.
UnitedHealthcare follows CMS methodology; services furnished for less than 30 minutes in the calendar month are not reimbursable.

ALL of the following

Non-reimbursable CPO codes (NONE of):
- 99374
- 99377
- 99379
- S0220
- S0221
- S0250

Coding — Eligible and Non-eligible Codes; Time Requirement

Eligible CPO codesmixedCovered

99375	Care Plan Oversight - eligible (per policy list mapping)
99378	Care Plan Oversight - eligible (per policy list mapping)
99380	Care Plan Oversight - eligible (per policy list mapping)
G0086	Care Plan Oversight - eligible
G0087	Care Plan Oversight - eligible
G0179	Care Plan Oversight - eligible (and mapped series)
G0180	Care Plan Oversight - eligible (mapped)
G0181	Care Plan Oversight - eligible (mapped)
G0182	Care Plan Oversight - eligible (mapped)
G2014	Care Plan Oversight - eligible (mapped)

1–10 of 11

1/2

Non-eligible CPO codesmixedNot Covered

99374	Not reimbursable for CPO (policy lists associated non-eligible series)
99377	Not reimbursable for CPO
99379	Not reimbursable for CPO
S0220	Not reimbursable for CPO
S0221	Not reimbursable for CPO
S0250	Not reimbursable for CPO
S0270	Not reimbursable for CPO
S0271	Not reimbursable for CPO
S0272	Not reimbursable for CPO

Minimum time per claim period

Minimum time per claim period30 minutes per calendar month

Time measurement periodMeasured within a single calendar month (30-day period used for code selection guidance)

Reimbursement conditionCPO reimbursed only when physician furnished at least the minimum time within the calendar month

Submission, Billing, and Time Requirements for Providers

Documentation Required

Submit CPO claims on CMS-1500 and meet 30-minute monthly minimum

Submit claims on the CMS-1500 form (or electronic equivalent). Care Plan Oversight (CPO) is reimbursable only when the physician or other qualified health care professional furnishes at least 30 minutes of oversight within the calendar month; select the CPO code based on complexity and approximate time within that 30-day period.

Use CMS-1500 (1500 Health Insurance Claim Form) or electronic equivalent for all services governed by this policy.
Code selection for CPO is determined by complexity and approximate time spent within a 30-day period.
Payment is only for months in which ≥30 minutes of CPO were furnished.

Key Definitions

Care Plan Oversight — definition

DefinitionCare Plan Oversight (CPO) Services refer to physician and other qualified health care professional supervision of patients under the care of home health agencies, hospice, or nursing facilities.

Coding basisReported separately from office/outpatient, hospital, home, nursing facility, or domiciliary service codes; code selection determined by complexity and approximate time within a 30-day period.

Reimbursement requirementCovered only when at least 30 minutes of CPO is furnished in the calendar month for which payment is claimed (per CMS methodology).

CMS-1500

Form nameCMS-1500 (a/k/a 1500 Health Insurance Claim Form) or its electronic equivalent is the required claim form for services governed by this policy.

Application scopeThis policy applies to services reported using the CMS-1500 or its electronic equivalent for all products and all network and non‑network physicians and other qualified health care professionals.

Accuracy responsibilityProviders are responsible for submission of accurate claims using the appropriate claim form per policy instructions.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyCare Plan Oversight (CPO) reimbursement

Policy CodePolicy 2026R0033A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionSubmit claims on CMS-1500 (or electronic equivalent); CPO is reimbursable only when at least 30 minutes of oversight is furnished in the calendar month.

SourceLink

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