CurrentUnitedHealthcarePolicy 2026R0113A

CMS-1500 From-To Date and Units (Grouping) Reimbursement Policy

Governs how services billed on the CMS-1500 (1500) form may be grouped using 'from' and 'to' dates and units, and which services are exempt; applies to UnitedHealthcare Commercial and Individual Exchange plans and all providers submitting on the 1500 form except listed supplier exceptions.

Policy Summary

PayerUnitedHealthcare

PolicyCMS-1500 From-To Date and Units (Grouping) Reimbursement Policy

Policy CodePolicy 2026R0113A

Change TypeTemplate revision and attachment updates (non-material)

Effective Date

Next Review Date

Key ActionWhen grouping identical services on consecutive days, submit 'from' and 'to' dates and ensure units equal or are divisible by the number of days; otherwise resubmit each service on separate lines with matching dates and units.

SourceLink

POLICY UPDATE CHANGES

Attachments Section: From-To Policy Exceptions and From-To Per Diem Per Day Lists updated.

Transferred content to shared policy template that applies to both UnitedHealthcare Commercial and Individual Exchange benefit plans.

1policy number identifier present

All UH Commercialapplies to (Commercial)

All Individual Exchangeapplies to (Exchange)

Multiplehistory entries

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.

Coverage Criteria

Coverage Criteria and Rules for Grouping

UnitedHealthcare will consider reimbursement for grouped claim lines only when specified conditions are met; certain services are exempt from grouping rules.

Grouping is defined as services that share a procedure code, place of service, charge, and individual provider, and are provided on consecutive days; the number of days must correspond to the number of units reported in field 24G of the 1500 form.

When a 'from' - 'to' date span is greater than one day, units must correspond to or be equally divisible by the number of days in the span; if they do not, the claim will not be processed and services must be resubmitted on separate claim lines with matching dates and units.

Grouping is allowed only for identical services on consecutive days with identical place of service, procedure code, charges, and individual provider.

Exceptions (ONE of)

Codes described as per week, per month, or per course of treatment (these are not intended to be reported on consecutive dates but may be appropriate to report with a 'from' and 'to' date).
Codes that represent drugs, contrast, or radiopharmaceutical imaging materials.
Global maternity codes.
Time-based anesthesia codes.
Unlisted codes.

Coding, Units, and Examples

Examples and ExemptionsHCPCS

S9328

Example HCPCS code reported once per day (illustrative of codes that should be reported once daily)

Exempt CPT/HCPCS Categoriesmixed

per week/per month/per course of treatment	Codes whose descriptions state per week, per month, or per course of treatment (considered exceptions to grouping policy)
drugs/contrast/radiopharmaceuticals	Codes that represent drugs or contrast and radiopharmaceutical imaging materials
global maternity codes	Global Maternity Codes
time-based anesthesia codes	Time based Anesthesia codes
unlisted codes	Unlisted codes

Units-to-days correspondence

RuleUnits must correspond to or be equally divisible by the number of days in the 'from'–'to' date span; if not, the claim will not be processed and must be resubmitted on separate lines with matching units.

Failure consequenceClaims with a 'from'–'to' span >1 day and units that do not correspond or are not equally divisible will be returned as unprocessable and require resubmission.

Example guidanceWhen grouping, enter the number of days or units in column G (24G) and ensure that number corresponds to the days between 'From' and 'To' dates.

NUCC/CMS alignmentPolicy follows NUCC instructions and CMS Medicare Claims Processing guidance that units in 24G must match the number of days when 'from' and 'to' dates are used.

Provider Billing & Submission Requirements

Note

Scope Exceptions for Certain Suppliers

This policy does not apply to services reported by the following supplier types when they bill under their typical monthly or per-supplier billing cycles: Home Health Care, Home Infusion, Durable Medical Equipment (DME), Orthotics and Prosthetics (O&P). These suppliers are excluded unless the code description indicates the service or supply should be reported only once per day (for example, HCPCS S9328). Also excluded from this policy are CPT/HCPCS codes reported for time‑based anesthesia services, codes with a time span in their description, unlisted codes, global maternity codes, drugs, and ambulance mileage.

Home Health Care suppliers (excluded unless code description requires once‑daily reporting)
Home Infusion suppliers (excluded unless code description requires once‑daily reporting)
Durable Medical Equipment suppliers (excluded unless code description requires once‑daily reporting)
Orthotics and Prosthetics suppliers (excluded unless code description requires once‑daily reporting)
Time‑based anesthesia CPT/HCPCS codes (excluded)
Codes with a time span in their description (excluded)
Unlisted procedure codes (excluded)
Global maternity codes (excluded)
Drugs and ambulance mileage (excluded)

Definitions

Grouping — definition

TermGrouping refers to reporting services that share the same procedure code, place of service, charge and individual provider and that were provided on consecutive days.

ConditionGrouping is allowed only when the services are identical on consecutive days and units equal the number of days reported.

Submission requirementWhen grouping, submit identical lines with matching place of service, procedure code, charges and provider; units must be divisible by the span of days.

From/To Dates and Units (1500 fields)

1500 paper fields'From' and 'To' dates are entered in field 24A (DATE(S) OF SERVICE); 'Days or Units' are entered in field 24G (DAYS OR UNITS).

Electronic equivalent

Billing Rule

Claim Form Field Guidance

Follow NUCC and CMS guidance when completing paper and electronic 1500 claims. For paper CMS‑1500 (02/12): enter the service dates in field 24A (DATE(S) OF SERVICE) using a single date in 'From' if one date, or both 'From' and 'To' when spanning multiple consecutive days. Enter Days or Units in field 24G (DAYS OR UNITS). When grouping identical services across consecutive days, the number of units in 24G must equal or be equally divisible by the number of days indicated by the 'From' and 'To' dates. CMS returns claims as unprocessable if a multi‑day span is present without a valid 'To' date. For electronic claims, follow HIPAA 837P guidance and the NUCC 1500–837P crosswalk to populate the equivalent electronic service date and unit fields.

Paper CMS‑1500 (02/12): 24A = From/To DATE(S) OF SERVICE; 24G = DAYS OR UNITS
If only one date of service, enter it under 'From' and leave 'To' blank or repeat 'From'
When Grouping identical services on consecutive days: place of service, procedure code, charges, and individual provider must be identical
Units (24G) must correspond to or be equally divisible by the number of days in 'From'–'To'; otherwise the line will not be processed
Electronic claims: use 837 Professional transaction set per HIPAA and NUCC crosswalk to map From/To and units