CurrentUnitedHealthcarePolicy N/A

Add-on code reimbursement for facility UB-04 claims

Defines UnitedHealthcare Community Plan's reimbursement policy for CPT/HCPCS add-on codes billed on UB-04 (or electronic equivalent) for Medicaid products and applies to all facilities and qualified health care professionals for covered services.

Policy Summary

PayerUnitedHealthcare

PolicyAdd-on code reimbursement for facility UB-04 claims

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionReport add-on codes only in addition to the appropriate primary service by the Same Facility (same Federal Tax ID).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

UB-04claim form applicability

+17312/+17314/+17315example code group

same claimreporting requirement

FL,KS,NE,NY,OH,VA,TX,WA,WIstate exceptions

Add-on Code Coverage Criteria

Add-on code coverage criteria

Covered when ALL of the following are met:

Add-on codes are reimbursable only when reported in addition to the appropriate primary service by the Same Facility (same Federal Tax Identification Number).

Add-on codes must be performed by the Same Facility reporting the primary service/procedure.

Add-on codes reported as stand-alone codes are not reimbursable in accordance with CPT and CMS guidelines.

Unless otherwise specified within this policy, add-on procedures must be reported with the primary procedure for the same date of service; UnitedHealthcare recommends that add-on and primary be reported on the same claim.

When definitive/interpretive sources apply

Policy Summary

PayerUnitedHealthcare

PolicyAdd-on code reimbursement for facility UB-04 claims

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionReport add-on codes only in addition to the appropriate primary service by the Same Facility (same Federal Tax ID).

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.

Relevant Codes and Facility Reporting Rules

Mohs procedure codesCPTCovered

17311	Mohs micrographic surgery primary code
+17312	Mohs add-on (may be on different date)
17313	Mohs micrographic surgery primary code
+17314	Mohs add-on (may be on different date)
+17315	Mohs add-on (may be on different date)

Same Facility requirement

RequirementAdd-on codes must be performed by and reported by the Same Facility (same Federal Tax Identification Number) as the primary service.

ApplicabilityApplies to add-on CPT and HCPCS codes per UnitedHealthcare Community Plan guidance.

Exception handlingWhen a Definitive Source specifies primary codes for an add-on, those primary codes must be used in reporting.

Billing and Reporting Guidance for Providers

Billing Rule

Add-on reporting rules

Add-on codes are reimbursable only when billed in addition to the appropriate primary service by the same facility reporting the same Federal Tax Identification Number. Add-on codes billed as stand-alone services are not reimbursable. For add-on relationships not explicitly defined by CPT or CMS, UnitedHealthcare will interpret CPT, CMS, and specialty society guidance to identify required primary/add-on pairs. Unless otherwise specified, add-on procedures must be reported with the primary procedure on the same date of service.

Add-on codes must be billed by the Same Facility (same Federal Tax ID).
Stand-alone reporting of add-on codes is not reimbursable.
When CPT/CMS do not specify a primary code, UnitedHealthcare will interpret authoritative sources to define the required primary/add-on relationship.

Billing Rule

Infusion service billing guidance

Hospitals should report only one initial drug administration service per encounter for each distinct vascular access site. Subsequent services administered through the same vascular access site should be reported using the sequential, concurrent, or additional hour add-on codes. The add-on infusion code does not have to be billed on the same date of service as the initial drug administration; however, both the initial drug service and any corresponding add-on infusion codes must be reported on the same claim.

Only one initial drug administration service (including infusion) is allowed per encounter per distinct vascular access site.
Subsequent services via the same access site should use sequential/concurrent/additional hour codes (add-on codes).
Initial drug service and corresponding add-on infusion codes must appear on the same claim even if dates of service differ.

Billing Rule

Mohs billing guidance

Mohs micrographic surgery involves combined surgical and pathology services; several Mohs add-on codes (+17312, +17314, +17315) may be performed on a different date than the primary Mohs procedure. Even when dates of service differ, Mohs add-on codes should be reported on the same claim as the primary Mohs procedure. Ensure add-on codes are billed in conjunction with their primary Mohs procedure per CPT definitions and UnitedHealthcare guidance.

Mohs add-on codes include +17312, +17314, +17315.
Add-on codes may have a different date of service than the primary Mohs code but must be billed on the same claim as the primary procedure.
Report Mohs add-on codes only in combination with the appropriate primary Mohs procedure as specified by CPT.

Key Definitions

Add-on code

DefinitionAn add-on code describes additional intra-service work associated with a primary service or procedure and is always reported in addition to the primary service/procedure.

DesignationMany add-on codes are designated by the AMA with a '+' symbol and are listed in CPT Appendix D.

Reporting ruleAdd-on codes must be reported with an appropriate primary service; unless otherwise specified, they should be reported for the same date of service.

Same Facility

DefinitionSame Facility is the facility rendering health care services that reports the same Federal Tax Identification Number.

Reporting implicationAdd-on codes must be performed by and reported by the Same Facility reporting the primary service unless otherwise specified.

Claim recommendationUnitedHealthcare recommends reporting add-on and primary procedure codes on the same claim form when possible.

Stand-alone code

DefinitionA Stand-alone code is a code reported without another primary service/procedure code by the same individual physician or other health care professional.

ReimbursementAdd-on codes reported as stand-alone codes are not reimbursable per CPT and CMS guidelines.

ContextStand-alone reporting is not acceptable for add-on CPT/HCPCS codes under this policy unless specifically allowed by the policy language.

Definitive/Interpretive Source

Definitive SourceSources that contain the exact codes, modifiers, or very specific instructions (e.g., CPT parentheticals) and may explicitly specify required primary/add-on pairings.

Interpretive SourceSources that provide guidelines without exact code or modifier listings and require interpretation to map codes to guidance.

Policy applicationWhen Definitive Sources do not specify primary codes, UnitedHealthcare will interpret CPT, CMS, and specialty society guidance to define primary/add-on relationships for reimbursement.