Care Plan Oversight (CPO) reimbursement
Defines UnitedHealthcare reimbursement policy for Care Plan Oversight services (physician/qualified clinician supervision of home health, hospice, or nursing facility patients) and lists eligible and non-eligible CPT/HCPCS codes and time requirements. Applies to UnitedHealthcare Commercial and Individual Exchange plans.
No material clinical or coverage changes in this revision.
Care Plan Oversight Coverage Criteria
Care Plan Oversight coverage criteria
Coverage requires meeting code and time criteria as follows:
ALL of the following
- At least 30 minutes of Care Plan Oversight performed by the physician or qualified health care professional within the calendar month for which payment is claimed (per CMS guidance).
- Claim must use one of the eligible codes listed by UnitedHealthcare for CPO reimbursement (see eligible list).
- Excluded codes: Codes listed on the non-eligible list are not reimbursable for Care Plan Oversight services.
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.