CurrentUnitedHealthcarePolicy 2025R0113D

CMS-1500 claim from/to date and units reimbursement rules

Governance of how services billed on the CMS-1500 form must report 'from'/'to' dates and units for reimbursement; applies to UnitedHealthcare Commercial and Individual Exchange providers submitting CMS-1500 claims.

Policy Summary

PayerUnitedHealthcare

PolicyCMS-1500 claim from/to date and units reimbursement rules

Policy CodePolicy 2025R0113D

Change TypeNo material change

Effective Date

Next Review Date

Key ActionResubmit claim lines separately when 'from'/'to' dates and units do not correspond or are not equally divisible by the number of days indicated.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1500 formclaim form governed

NUCC/CMSguidance alignment

exceptions listexceptions

From-To Date and Units Processing Rules

From-To date and units processing rules

Processing criteria for CMS-1500 claim lines with from/to date ranges:

Policy Summary

PayerUnitedHealthcare

PolicyCMS-1500 claim from/to date and units reimbursement rules

Policy CodePolicy 2025R0113D

Change TypeNo material change

Effective Date

Next Review Date

Key ActionResubmit claim lines separately when 'from'/'to' dates and units do not correspond or are not equally divisible by the number of days indicated.

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.

Coding Rules and Exceptions

From-To exceptions and per diem/per day listsmixed

No codes listed

Types of codes exempt (descriptive list)mixed

Per week/per month/per course codes	Codes whose descriptions indicate per week, per month, or per course of treatment (exception to from-to/unit matching).
Drugs/Contrast/Radiopharmaceuticals	Codes that represent drugs or contrast and radiopharmaceutical imaging materials (exempt).
Global Maternity Codes	Global maternity procedure codes (exempt).
Time-based Anesthesia Codes	Anesthesia codes reported by time (exempt).
Unlisted Codes	Unlisted procedure codes (exempt).

Units-to-days correspondence

RuleWhen a CMS-1500 claim line has a from-to date span greater than one day, the units entered must correspond to or be equally divisible by the number of days indicated; otherwise the claim line will not be processed.

ConsequenceClaim lines with mismatched from/to dates and units must be resubmitted as separate lines with units matching the corresponding from and to dates.

CMS/NUCC alignmentPolicy aligns with NUCC and CMS guidance that when from and to dates are shown for identical services, the number of days or units must be entered and a missing valid 'to' date for spans >1 day makes the claim unprocessable.

What Providers Must Do

Billing Rule

Correct mismatched From/To dates and units by resubmitting lines separately

Resubmit any CMS-1500 claim lines as separate lines when the 'From'/'To' date span is greater than one day and the units entered do not correspond to or are not equally divisible by the number of days in that span. Lines that do not meet this correspondence will not be processed and must be broken out so each line’s units match its corresponding From and To dates.

If from-to span > 1 day, units must correspond to or be equally divisible by the number of days indicated.
If dates and units do not correspond the claim line will not be processed and must be resubmitted as separate lines with matching units and dates.
CMS returns claims as unprocessable if a date span >1 day lacks a valid To date; ensure To is present when span >1 day.

Note

Policy exclusions — codes and service types not subject to this rule

Do not apply this From/To Units policy to services specifically excluded by the policy: time-based anesthesia codes, codes with a time span in their description, unlisted codes, global maternity codes, drugs (including contrast and radiopharmaceuticals), ambulance mileage, and certain per‑week/per‑month/per‑course codes. Also exclude Home Health Care, Home Infusion, DME, and Orthotics/Prosthetics suppliers unless the code description indicates it should be reported once daily.

Exceptions include codes described as per week, per month or per course of treatment.
Drugs, contrast and radiopharmaceuticals, global maternity, time‑based anesthesia, unlisted codes, and ambulance mileage are excluded.
Home Health, Home Infusion, DME, and Orthotics/Prosthetics suppliers are excluded except when the code description requires once‑daily reporting (e.g., HCPCS S9328).

Key Terms

Grouping — definition

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

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

Units/days matchThe number of days in the grouped span must correspond to the number of units reported in field 24G of the CMS-1500 form.

Line-level identityFor grouping, the place of service, procedure code, charges, and individual provider for each line must be identical.