CurrentUnitedHealthcarePolicy N/A

1500 claim from-to date and units grouping rules

Defines UnitedHealthcare Community Plan reimbursement rules for reporting 'from' and 'to' service dates and units on CMS-1500 (and electronic 837P) claims, and lists exceptions and state-specific deviations; applies to Community Plan Medicaid products and providers filing on the 1500 form.

Policy Summary

PayerUnitedHealthcare

Policy1500 claim from-to date and units grouping rules

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionResubmit claim lines when 'from' and 'to' dates and units do not correspond or are not equally divisible; submit separate lines with units matching the dates.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1policy applies to UnitedHealthcare Community Plan Medicaid products

consecutive days onlyGrouping allowed only for identical services on consecutive days

units must equal or be equally divisibleUnits must correspond to or be equally divisible by number of days in from-to span

multiple statesState-specific code exceptions listed

attachments maintainedAttachments referenced for exempt codes and per-diem lists

Policy Summary

PayerUnitedHealthcare

Policy1500 claim from-to date and units grouping rules

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionResubmit claim lines when 'from' and 'to' dates and units do not correspond or are not equally divisible; submit separate lines with units matching the dates.

SourceLink

On This Page

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.

From–To Date and Units Processing Rules

From-To date and units processing criteria

Processing criteria for claim lines that span multiple dates of service:

When a claim line includes a 'from' and 'to' date span greater than one day, the number of units entered must correspond to or be equally divisible by the number of days indicated in the 'from'–'to' span. If units do not correspond or are not equally divisible, the claim line will not be processed and must be resubmitted as separate lines with units matching the corresponding dates.

CMS and NUCC guidance must be followed when completing CMS-1500/NUCC data set fields: single-date services should have the date entered in 'From' (leave 'To' blank or repeat 'From'); when grouping services for consecutive days, enter the number of days/units in field 24G and ensure units equal or are equally divisible by the number of days.

Grouping (reporting multiple days on one line) is allowed only when place of service, procedure code, charges, and individual provider are identical and the services are on consecutive days. When grouping is used, units submitted should be equally divisible by the number of days in the 'from'–'to' span.

Exceptions (one of the following may apply)

Certain CPT and HCPCS codes described as per week, per month, or per course of treatment may be reported with a 'from' and 'to' date and are exempt from the consecutive-day grouping restriction.
Codes that represent drugs, contrast, and radiopharmaceutical imaging materials are exempt from this grouping restriction.
Global maternity codes, time-based anesthesia codes, and unlisted codes are exempt from this grouping restriction.
Home Health Care, Home Infusion, DME, orthotics and prosthetics suppliers are excluded from this policy except when they report codes whose description indicates they should be reported once daily (units must correspond to 'from'/'to' dates; e.g., HCPCS code S9328).

If a claim cannot be processed because service dates cannot be determined (for example, a single line showing a multi-month span with units that do not match days), UnitedHealthcare Community Plan will return the claim as unprocessable and require resubmission on separate lines with matching dates and units (see claim example in guidance).

Code Exceptions, Examples, and Units-to-Days Rules

Example HCPCS codesHCPCS

S9328	Example HCPCS code described as once per day (illustrative)
T2022	State-specific exception example (Colorado)

State-specific exempt codesmixed

B4150	State-exempt code (Indiana)
H0004	State-exempt code (Indiana)
S5100	State-exempt code (Indiana)
S5125	State-exempt code (Indiana)
S5130	State-exempt code (Indiana)
S5140	State-exempt code (Indiana)
S5141	State-exempt code (Indiana)
S5150	State-exempt code (Indiana)
S5160	State-exempt code (Indiana)
S5161	State-exempt code (Indiana)

1–10 of 50

1/5

New Jersey specific exemptionsmixed

T2025

Exempt from this policy for all New Jersey Medicaid lines of business

Colorado specific exemptionHCPCS

T2022

Providers allowed to bill with only 1 unit and a date span (Colorado)

Units-to-Days Divisibility Rule

RuleWhen the 'from'–'to' date span is greater than one day, units entered must correspond to or be equally divisible by the number of days in the span.

ConsequenceClaim lines where dates and units do not correspond or are not equally divisible will not be processed and must be resubmitted as separate lines with units matching the corresponding dates.

CMS/NUCC basisConsistent with NUCC and CMS guidance: enter number of days/units in column G; CMS may return claims as unprocessable if a valid 'to' date is missing for spans over 1 day.

Resubmission and Billing Actions Required

Billing Rule

Resubmit claim lines when dates and units don't match

If a claim line spans more than one day, units must correspond to or be equally divisible by the number of days in the from–to date span. If the from/to dates and units do not correspond or are not equally divisible, the claim line will not be processed and the services must be resubmitted on separate claim form lines with units that match the corresponding from and to dates.

Resubmit each service on its own line so the dates reported (From and To) match the units entered in field 24G.
Claims with a multi-day span and missing/invalid To date or mismatched units will be returned as unprocessable and must be corrected and resubmitted.

Definitions and Grouping

Grouping (definition and criteria)

DefinitionGrouping refers to reporting services that share the same procedure code, place of service, charge, and individual provider.

Consecutive days requirementGrouping is allowed only for services provided on consecutive days.

Units correspondenceThe number of days in the grouped span must correspond to the number of units reported in field 24G of the 1500 form.

Identical-service criteriaEach grouped line must have identical procedure code, place of service, charges, and individual provider to qualify for grouping.