CurrentColorado Rocky Mountain Health PlansPolicy 2026R0102A

Time Span Codes reimbursement

Defines UnitedHealthcare reimbursement rules for CPT and HCPCS codes that specify time periods (e.g., weekly, monthly) for services billed on CMS-1500 or UB04 forms and applies to UnitedHealthcare Commercial and Individual Exchange plans and all network and non-network providers.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyTime Span Codes reimbursement

Policy CodePolicy 2026R0102A

Change TypeTemplate and list updates (2024-2026)

Effective Date

Next Review Date

Key ActionSubmit accurate claims using the code(s) that correctly describe services on CMS-1500 or UB04; reimbursement follows CPT/HCPCS time-span parameters.

SourceLink

POLICY UPDATE CHANGES

Transferred content to shared policy template that applies to both UnitedHealthcare Commercial and Individual Exchange benefit plans and updated Application section.

Time Span Codes List and Comprehensive/Component Codes lists were updated multiple times (dates shown).

Commercialplan applicability

Individual Exchangeplan applicability

2026R0102Aidentifier

calendar month / 30dtime span types

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Time Span Reimbursement Criteria

Time Span reimbursement criteria

UnitedHealthcare reimburses Time Span Codes according to the time parameter specified in code descriptions, CPT parentheticals, or AMA/CMS guidance. Specific rules include:

Reimburse a CPT/HCPCS Time Span Code once during the specified time period (e.g., calendar month, 30 days) for the same member when provided by the Same Group Physician and/or Other Qualified Health Care Professional.

When related Time Span Codes that share common components are reported during the same time span for the same patient by the Same Group Physician and/or Other Qualified Health Care Professional, only the code with the most comprehensive description is reimbursable; the other code is considered inclusive and not separately reimbursable. No modifiers will override this denial.

For CPT codes 93224-93227 reported with modifier 52 (reduced services for less than 12 hours of continuous recording), the Time Span Codes Policy is not applied; reimbursement is determined under the Reduced Services Policy instead.

UnitedHealthcare determines 'Calendar Month' time spans as an individually named month (e.g., January). A service provided on the last day of one month (e.g., Dec 31) and again on the first day of the next month (e.g., Jan 1) may be reimbursed as separate monthly services. If a code description specifies 30 days, the code may be submitted again on the 30th day from the prior date of service.

Modifiers (for example, 59 or 76) are not recognized to bypass Time Span restrictions; reimbursement is based on the time span parameter specified in the code description, CPT parentheticals, and other AMA/CMS coding guidance.

Comprehensive/Component Codes and Frequency Enforcement

Comprehensive and component Time Span CodesCPTCovered

93268	Comprehensive external electrocardiographic monitoring component (see policy for related component codes)
93270	Component code related to 93268 (not separately reimbursable if reported with 93268 in same 30-day period)
93271	Component code related to 93268 (not separately reimbursable if reported with 93268 in same 30-day period)
93272	Component code related to 93268 (not separately reimbursable if reported with 93268 in same 30-day period)

Time span frequency enforcement

Enforcement ruleCodes that specify a time period (for example, calendar month or 30 days) are reimbursed only once during that specified time period for the same member when provided by the Same Group Physician and/or Other Qualified Health Care Professional.

Time parameter sourceTime span is determined by the code description, CPT parentheticals, or AMA/CMS coding guidance.

Modifier limitationModifiers (e.g., 59, 76) are not recognized to bypass Time Span restrictions; reimbursement follows the time span parameter in the code description or coding guidance.

Example — 30 daysIf a code description specifies 30 days, the code can be submitted for reimbursement again on the 30th day from the prior date of service.

Claims Submission, Modifiers, and ESRD Grouping Rules

Billing Rule

Claims submission and applicability

You are responsible for submission of accurate claims. Submit claims using the correct codes and modifiers that accurately describe services provided. This policy applies to services billed on CMS-1500 forms (or electronic equivalents) and, when specified, UB04 forms. Coding methodology, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy; other payer rules or benefit documents may modify reimbursement.

Submit accurate claims with correct CPT/HCPCS and modifiers
Policy applies to CMS-1500 (electronic equivalent) and UB04 when specified
Applies to all products and all network and non-network physicians and other qualified health care professionals

Billing Rule

External ECG recording with modifier 52

CPT codes 93224–93227 are for external electrocardiographic recording services up to 48 hours by continuous rhythm recording and storage. CPT guidance specifies that when there are <12 hours of continuous recording, modifier 52 (Reduced Services) should be used. When modifier 52 is appended to 93224–93227, the Time Span Codes Policy is not applied; instead, reimbursement follows the payer's Reduced Services Policy for codes appended with modifier 52.

Key Definitions

Definition of Calendar Month

DefinitionCalendar Month is the time span referring to an individually named month of the year (e.g., January, February) and includes codes with 'Calendar Month' in their description.

Boundary exampleA member may receive a Calendar Month supply on December 31 for December and again on January 1 for January.

ApplicationWhen a code description uses 'Calendar Month,' UnitedHealthcare interprets the time span as the named calendar month rather than a fixed day count.

Definition of Same Group Physician and/or Other Qualified Health Care Professional

Group definitionSame Group Physician and/or Other Qualified Health Care Professional means all physicians and/or other qualified health care professionals of the same group reporting the same Federal Tax Identification number.

Policy Changes and Updates

2026-01-01policy version changeLatest

Time Span Codes List updated; history entries prior to 1/1/2024 were archived.

2025-06-29policy version change

Time Span Codes List updated; history entries prior to 6/29/2023 were archived.

2025-03-30policy version change

Time Span Codes List updated; history entries prior to 3/30/2023 were archived.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyTime Span Codes reimbursement

Policy CodePolicy 2026R0102A

Change TypeTemplate and list updates (2024-2026)

Effective Date

Next Review Date

Key ActionSubmit accurate claims using the code(s) that correctly describe services on CMS-1500 or UB04; reimbursement follows CPT/HCPCS time-span parameters.

SourceLink

On This Page

Affected codes: CPT 93224, 93225, 93226, 93227
Use modifier 52 when continuous recording is <12 hours
When modifier 52 is present, Time Span Codes Policy does not apply — Reduced Services Policy governs reimbursement

Billing Rule

ESRD monthly grouping rule

CPT codes 90951–90962 (ESRD outpatient services) are grouped by patient age and number of face-to-face physician or other qualified health care professional visits per month. UnitedHealthcare reimburses a single most comprehensive outpatient ESRD code per age category once per month.

Reimburse one most comprehensive ESRD code per age category per month
Age categories: under 2 years, 2–11 years, 11–19 years, and 20 years and older
Grouping based on number of face-to-face visits (1, 2–3, or 4+ per month)

Time Span reimbursement limits (once per time period) apply across providers who share the same federal tax ID.

Claiming implicationServices furnished by providers under different federal tax IDs are evaluated separately for Time Span enforcement.

Definition of Time Span Code

What it isTime Span Code: a CPT or HCPCS code that specifies a time period for which it should be reported (e.g., weekly, monthly).

Source of time parameterThe applicable time period is defined by the code description, CPT book parentheticals, or AMA/CMS coding guidance.

Reimbursement ruleThese codes are subject to the Time Span frequency enforcement — reimbursed once per the specified time span for the same member and same group providers.

2025-01-01policy version change

Comprehensive and Component Time Span Codes list updated; Time Span Codes List attachment updated and history entries prior to 1/1/2023 were archived.

2024-09-22policy version change

Time Span Codes List updated; history entries prior to 9/22/2022 were archived.

2024-04-01template update

Transferred content to shared policy template applying to UnitedHealthcare Commercial and Individual Exchange plans and updated the Application section; history entries prior to 4/22/2022 were archived.

2024-03-31policy version change

Time Span Codes List updated; history entries prior to 3/31/2022 were archived.

2010-03-15policy implemented

Policy implemented by UnitedHealthcare Employer & Individual.

2009-10-14policy approved

Policy approved by the National Reimbursement Forum.