CurrentColorado Rocky Mountain Health PlansPolicy 2026R0102A

Time Span Codes reimbursement

This reimbursement policy governs how CPT and HCPCS Time Span Codes (codes that specify a reporting time period such as weekly or monthly) are reimbursed for UnitedHealthcare Commercial and Individual Exchange benefit plans and applies to services billed on the CMS-1500 or electronic equivalent by network and non-network providers.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyTime Span Codes reimbursement

Policy CodePolicy 2026R0102A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionReimburse a CPT/HCPCS Time Span Code only once during its defined time period based on the code description; modifiers (e.g., 59, 76) will not override the time span.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

once per periodReimbursement frequency

Calendar MonthCalendar Month example

codes listedComprehensive/component examples

93224-93227Special modifier handling

90951-90962ESRD grouping

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Time Span Code Reimbursement Criteria

Time Span reimbursement rules

Covered when ALL of the following criteria are met:

Reimburse a Time Span Code only once during the defined time period for the same member when provided by the Same Group Physician and/or Other Qualified Health Care Professional.

The applicable time period is determined from the CPT or HCPCS code description, CPT book parentheticals, and other AMA/CMS coding guidance (e.g., CPT book instructions).

For codes with a 'Calendar Month' designation, the time span is an individually named calendar month (e.g., December and January are separate months and may both be reimbursed if services occur on Dec 31 and Jan 1 respectively).

If a code description specifies 30 days, the code may be submitted again on the 30th day after the prior date of service.

When related Time Span Codes that share a common portion of their description are both 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 is inclusive and not separately reimbursable. No modifiers will override this denial.

CPT codes 93224–93227 appended with modifier 52 are NOT adjudicated under the Time Span Codes Policy; instead, they are processed under the Reduced Services Policy per CPT guidance for recordings under 12 hours.

For ESRD outpatient CPT codes 90951–90962, UnitedHealthcare will reimburse the single most comprehensive ESRD code submitted per age category once per month in alignment with CPT guidance.

Modifiers such as 59 or 76 are not recognized to permit additional reimbursement of a Time Span Code within its designated time span; reimbursement is governed by the code description and CPT/CMS guidance.

Code Examples and Time Span Definitions

Examples of comprehensive/component and special grouped codesCPTCovered

93268	Comprehensive service that is primary when billed with 93270–93272 during same 30-day period
93270	Component code — considered inclusive when billed with 93268 during same 30-day period
93271	Component code — considered inclusive when billed with 93268 during same 30-day period
93272	Component code — considered inclusive when billed with 93268 during same 30-day period
90951-90962	End-Stage Renal Disease outpatient CPT codes grouped by age and visit frequency; one most comprehensive code reimbursed per age category per month

Calendar month time span

DefinitionCalendar Month is defined as an individually named month of the year (e.g., January, February); services billed with a Calendar Month time span may be submitted once for that named month (e.g., Dec 31 counts for December and Jan 1 counts for January).

Rebilling ruleA code with a Calendar Month designation may be billed again at the start of the next calendar month (example: service on Dec 31 and again on Jan 1).

Source guidanceTime span determination uses the code description and CPT/CMS guidance; Calendar Month is the named month interpretation used by UnitedHealthcare.

30-day time span

Definition30-day time span means if a code description specifies 30 days, the code may be submitted again on the 30th day from the prior date of service.

Billing, Modifiers, and Reimbursement Frequency

Billing Rule

External Electrocardiographic Recording Services - Modifier 52 Handling for 93224–93227

CPT codes 93224–93227 (external electrocardiographic recording services up to 48 hours) when reported with modifier 52 (Reduced Services) must be billed with modifier 52 if the continuous recording is less than 12 hours. When modifier 52 is appended to CPT code 93224, 93225, 93226, or 93227, Colorado Rocky Mountain Health Plans does not apply the Time Span Codes Policy to these services. Instead, reimbursement is governed by the Reduced Services Policy, which addresses payment adjustments for codes billed with modifier 52.

Affected codes: CPT 93224, 93225, 93226, 93227
Modifier: 52 (Reduced Services) — required when continuous recording < 12 hours
Reimbursement: Time Span Codes Policy is not applied when modifier 52 is present; Reduced Services Policy applies instead

Policy Definitions

Calendar Month

TermCalendar Month — the Time Span policy defines Calendar Month as the individually named month of the year (e.g., January, February).

ContextApplies to CPT/HCPCS codes that include Calendar Month in their description; used to determine reimbursement frequency within that named month.

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

Same Group Physician and/or Other Qualified Health Care Professional

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

Reimbursement implicationTime Span Codes are reimbursed once per time period for services provided by the Same Group Physician and/or Other Qualified Health Care Professional for the same member.