CurrentUnitedHealthcarePolicy 2025R9037A

Medicare Advantage CMS-1500 reimbursement for supplies, drugs, and related HCPCS coding

Governs UnitedHealthcare Medicare Advantage reimbursement methodology for supplies, durable medical equipment, orthotics, prosthetics, biologicals, and drugs reported on the CMS-1500 (1500) claim form and applies to all Medicare Advantage products and network physicians/qualified health care professionals.

Policy Summary

PayerUnitedHealthcare

PolicyCMS-1500 reimbursement for supplies, drugs, and related HCPCS coding

Policy CodePolicy 2025R9037A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionUse Q4001–Q4051 for casting and splint supplies and do not bill A4570–A4590.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Q4001-Q4051Q codes required for casting and splint supplies instead of A4570-A4590

A4648,A4650Implantable tissue markers separately billable only with specified CPTs

POS 19,21,22,23,24Facility POS not separately reimbursable

99070,99072Non-specific supply CPTs not reimbursable

Nonfacility POS listPlaces of service considered nonfacility

Coverage and Billing Criteria

Reimbursement Criteria

Coverage and billing rules summarized by item type and place of service.

Reimbursement criteria for supplies, devices, and related items reported on the CMS-1500 form

Casting and splint supplies

HCPCS codes A4570, A4580, and A4590 are invalid for Medicare and are not reimbursable under UnitedHealthcare Medicare Advantage.
Physicians and other qualified health care professionals should bill casting and splint supplies using Q codes Q4001-Q4051 for reimbursement.

Implantable tissue markers and dosimeters

HCPCS codes A4648 (implantable tissue marker) and A4650 (implantable radiation dosimeter) are separately reimbursable only when billed on the same date of service with at least one of the following CPT codes: 19499, 32553, 49411, or 55876.

Policy Summary

PayerUnitedHealthcare

PolicyCMS-1500 reimbursement for supplies, drugs, and related HCPCS coding

Policy CodePolicy 2025R9037A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionUse Q4001–Q4051 for casting and splint supplies and do not bill A4570–A4590.

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 and Reimbursement Status

Invalid for Medicare - casting/splintHCPCSNot Covered

A4570	Casting and splint supplies (invalid for Medicare)
A4580	Casting and splint supplies (invalid for Medicare)
A4590	Casting and splint supplies (invalid for Medicare)

Separately payable with specific CPTsHCPCSCovered

A4648	Implantable tissue marker
A4650	Implantable radiation dosimeter

Non-specific CPT supply codesCPTNot Covered

99070	Supplies and materials, non-specific
99072	Non-specific supply/environmental code

Facility POS separate reimbursement — No separate reimbursement for supplies/DME/biologicals/drugs when billed on CMS-1500 from facility POS list.

Policy summaryUnitedHealthcare Medicare Advantage will not allow separate reimbursement for supplies, DME, orthotics, prosthetics, biologicals, and drugs reported with a HCPCS J code when submitted on a CMS-1500 claim form by a physician or other qualified health care professional from facility POS 19, 21, 22, 23, and 24.

Affected claim formCMS-1500 (1500) claim form for physician or other qualified health care professional submissions.

Applicable place of service (POS)POS 19, 21, 22, 23, 24 (facility POS where separate reimbursement is not allowed).

ReasonCMS facility payment systems (PPS and ASC) include costs for drugs and supplies in the facility payment; therefore these items are not separately reimbursable when billed on CMS-1500 from the listed facility POS.

Provider Billing Actions and Alerts

Note

Application

This reimbursement policy applies to all Medicare Advantage products and to services reported using the CMS-1500 Health Insurance Claim Form (or its electronic equivalent or successor form). It applies to all network physicians and other qualified health care professionals.

Billing Rule

Casting and Splint Supplies Billing

HCPCS codes A4570, A4580, and A4590 are not reimbursable for casting and splint supplies. Physicians and other qualified health care professionals should use the established Q-codes (Q4001–Q4051) for reimbursement of supplies used in creating casts and splints. For purposes of this policy, the following POS are considered nonfacility: 1, 3, 4, 9, 11, 13, 14, 15, 16, 17, 20, 33, 49, 50, 54, 55, 57, 60, 62, 65, 71, 72, 81 and 99.

Do not bill HCPCS A4570, A4580, A4590 for casting/splint supplies.
Use Q4001–Q4051 for casting and splint supply reimbursement.
Nonfacility POS: 1, 3, 4, 9, 11, 13, 14, 15, 16, 17, 20, 33, 49, 50, 54, 55, 57, 60, 62, 65, 71, 72, 81, 99.

Billing Rule

Implantable Tissue Markers Billing

Implantable tissue markers (A4648) and implantable radiation dosimeters (A4650) are separately billable and payable only when billed on the same date of service with one of the following CPT codes: 19499, 32553, 49411, or 55876. If A4648 or A4650 are not reported with at least one of these CPT codes on the same DOS, they are not separately reimbursable.

A4648 and A4650 are separately reimbursable only when billed with CPT 19499, 32553, 49411, or 55876 on the same date of service.
If not reported with one of these CPTs, A4648 and A4650 are not separately reimbursable.

Denial Risk

Facility POS Non-Reimbursement

Under Medicare payment systems for facilities (e.g., Inpatient/Outpatient PPS and ASC payment system), costs for drugs and supplies are considered included in the facility payment and are not separately reimbursable when reported on a CMS-1500 claim form by a physician or other qualified health care professional. UnitedHealthcare Medicare Advantage will not allow separate reimbursement for supplies, DME, orthotics, prosthetics, biologicals, and drugs reported with a HCPCS J code when submitted on a CMS-1500 by any physician or qualified health care professional in facility POS 19, 21, 22, 23, or 24.

No separate reimbursement when supplies/DME/orthotics/prosthetics/biologicals/drugs (including items reported with HCPCS J codes) are submitted on CMS-1500 by a physician/qualified provider in facility POS: 19, 21, 22, 23, 24.

Billing Rule

Non-specific Supply Codes

Non-specific CPT codes 99070 and 99072 are not separately reimbursable in any setting. For covered medical and surgical supplies, submit the appropriate Level II HCPCS code rather than CPT 99070 or 99072.

CPT 99070 — Not separately reimbursable; use appropriate Level II HCPCS.
CPT 99072 — Not separately reimbursable in any setting.

Definitions and Coding Terms

National Physician Fee Schedule Relative Value File — definition

TermNational Physician Fee Schedule Relative Value File

DefinitionA public use file that contains information on services covered by the Medicare Physician Fee Schedule (MPFS), including associated Relative Value Units (RVUs), a fee schedule status indicator, and payment policy indicators needed for payment adjustment (e.g., assistant at surgery, team surgery, bilateral surgery).

Use in policyUsed as the basis for reimbursement methodology and determining RVU-based payment adjustments.

Practice Expense Relative Value Units (PE RVU) — definition

TermPractice Expense Relative Value Units (PE RVU)

DefinitionThe portion of the Total Relative Value Units assigned to a particular CPT or HCPCS code for maintaining a practice, including rent, equipment, supplies, and nonphysician staff costs.

Relation to paymentPE RVUs contribute to the total RVU which influences Medicare Physician Fee Schedule payments.

Relative Value Units (RVU) — definition

TermRelative Value Units (RVU)

DefinitionThe assigned unit value of a particular CPT or HCPCS code; the associated RVU is either from the CMS NPFS Non-Facility Total value or Facility Total value.

RoleRVUs are used with the National Physician Fee Schedule to determine payment amounts and adjustments.