CurrentColorado Rocky Mountain Health PlansPolicy 2025R9055A

When services by Residents/Interns/Medical Students are reimbursable

Defines UnitedHealthcare Medicare Advantage reimbursement rules for services reported on the CMS-1500 form (or electronic equivalent) when services are performed by residents, interns, or medical students and when supervising/teaching physician modifiers are required. Applies to all network physicians and qualified health care professionals serving Medicare Advantage products.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyWhen services by Residents/Interns/Medical Students are reimbursable

Policy CodePolicy 2025R9055A

Change TypeRevised / Added

Effective DateJan 1, 2022

Next Review DateN/A

Key ActionDo not submit claims using the medical student taxonomy code 390200000X; when billing services involving residents or interns, append modifier GC or GE and ensure teaching physician documentation meets requirements.

SourceLink

POLICY UPDATE CHANGES

Policy version changes noted on 2023-02-09, 2023-07-01, 2024-09-01, and 2025-09-01 with updates to Overview, Reimbursement Guidelines, Definitions, and Q&A sections.

Policy implemented by UnitedHealthcare Medicare Advantage effective 1/1/2022.

CMS-1500Claim form governed by this policy

390200000XTaxonomy code for Medical Student (not payable)

GC, GEModifiers required for resident/intern services billed by licensed physicians

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Policy Summary

This policy, Policy Number 2025R9055A effective 2022-01-01, defines UnitedHealthcare Medicare Advantage reimbursement rules for services billed on the CMS-1500 form (or electronic equivalent) when services are performed by residents, interns, or medical students. It applies to all network physicians and other qualified health care professionals serving UnitedHealthcare Medicare Advantage products and explains when claims are payable based on the provider's Health Care Provider Taxonomy code, the presence and role of a teaching physician, required modifiers, and documentation expectations.

Claim form governed by this policyCMS-1500

Not-payable taxonomy code390200000X

Required modifiersModifiers GC, GE

When Services by Trainees Are Reimbursable

When services by Residents/Interns/Medical Students are reimbursable

Reimbursement depends on provider taxonomy code, presence/role of teaching physician, and proper use of modifiers and documentation.

ALL of the following

Claim must be submitted on CMS-1500 (or electronic equivalent) and include appropriate Health Care Provider Taxonomy code in Box 24J or electronic equivalent.
Services reported with a Medical Student taxonomy code (390200000X) will not be reimbursed.
If services were rendered by a Resident or intern but billed by a licensed practicing physician, the claim must be appended with modifier GC (teaching physician involved in part) or modifier GE (Primary Care Exception) to be considered for reimbursement.
Teaching physician must document personal performance of the service or physical presence during key/critical portions and provide independent documentation corresponding to the resident's documentation; without this, no reimbursement will be made.
If a teaching physician was not involved with any part of a patient's care, services may not be reported or reimbursed (except when reported with modifier GE under the Primary Care Exception).

Taxonomy Codes, Modifiers, and Claim Form Requirements

Medical student taxonomy (non-payable)mixedNot Covered

390200000X

Student in an Organized Health Care Education/Training Program (medical student) — services billed with this taxonomy code are not reimbursed.

Required modifiers for resident/intern servicesModifierCovered

GC	Resident did the service under direction of Teaching Physician — indicates teaching physician involvement; required for consideration of reimbursement.
GE	Service performed by resident without teaching physician present under Primary Care Exception — required for consideration of reimbursement under that exception.

Billing Rule

Do not bill for services using Medical Student taxonomy code

Claims that report the medical student taxonomy code (390200000X) will not be reimbursed. Do not submit payable services with this code.

390200000X

Billing Rule

Append modifier GC or GE when appropriate

When a licensed practicing physician submits claims for services rendered in part by a resident/intern, append modifier GC or GE per CMS definitions to be considered for reimbursement.

Claims must be submitted on the CMS-1500 form (or electronic equivalent) and report the provider's Health Care Provider Taxonomy Code in Box 24J. The taxonomy code for medical students is 390200000X, and services reported with that code will not be reimbursed. When licensed physicians submit claims for services rendered in part by a resident or intern, the claim must be appended with modifier GC or GE as appropriate for consideration of reimbursement.

Documentation and Denial Risks

Documentation Required

Teaching physician documentation requirements

Teaching physicians must personally document that they performed the service or were physically present during key or critical portions and include independent documentation that corresponds to the resident's documentation; without such documentation, no reimbursement can be made.

Denial Risk

Risk of denial when teaching physician not involved

Services furnished by an unlicensed resident/intern without any teaching physician involvement are not payable, creating a denial risk if billed improperly.

Exception: Primary Care Exception — report with modifier GE
Consequence: Claim may be denied if Teaching Physician was not involved

Policy Definitions

InternAn individual (sometimes referred to as a first-year resident) who is a doctor but may only practice medicine with guidance and supervision.

ResidentAn individual who participates in an approved graduate medical education (GME) program or a physician who is not in an approved GME program but who is authorized to practice only in a hospital setting.

Medical StudentAn individual who participates in an accredited educational program (for example, medical school) that is not an approved GME Program and who is not considered an intern or resident.

Teaching PhysicianA physician, other than an intern or resident, who involves residents in the care of their patients and must be present during all critical or key portions of the procedure and immediately available during the entire service for the service to be payable.

Physically PresentThe teaching physician is located in the same room (or partitioned/curtained area) as the patient and/or performs a face-to-face service.

Primary Care Exception

Policy Updates

2025-09-01revisedLatest

Policy version change noted on 9/1/2025 (version update).

2024-09-01revised

Policy version change noted on 9/1/2024 (version update).

2023-07-01revised

Policy version change noted on 7/1/2023 (Policy Application section updated; policy logo updated).