CurrentUnitedHealthcarePolicy 2026R0006B

UnitedHealthcare CMS-1500 Reimbursement Policy — Supplies, DME, Orthotics/Prosthetics, Biologicals and Drugs

Governs UnitedHealthcare reimbursement rules for HCPCS/CPT-coded supplies, drugs, DME, orthotics and prosthetics billed on the CMS-1500 form (and electronic equivalent) for Commercial and Individual Exchange plans; specifies when items are separately reimbursable based on place of service.

Policy Summary

PayerUnitedHealthcare

PolicyCMS-1500 Reimbursement — supplies, DME, orthotics/prosthetics, biologicals and drugs

Policy CodePolicy 2026R0006B

Change TypeTemplate and attachments updated (non-material)

Effective Date

Next Review Date

Key ActionSubmit accurate claims on the CMS-1500 (or electronic equivalent) and do not separately bill HCPCS supply/DME/drug codes when provided in facility POS 19,21,22,23,24,31,32 or when supplies are integral to an E/M or procedure in non-facility POS.

SourceLink

POLICY UPDATE CHANGES

Policy template was updated to apply to both UnitedHealthcare Commercial and Individual Exchange benefit plans.

Attachment sections (lists of non-separately reimbursable codes) were updated several times through 2024-2026.

POS 1,3,4,9,11,13,14,15,16,17,20,27,33,49,50,54,55,57,60,62,65,71,72,81,99Non-facility POS where supplies not separately reimbursable

POS 19,21,22,23,24Facility POS included in PPS

POS 31,32SNF / NF POS included

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 by Place of Service and Inclusion Rules

Coverage criteria by place of service and code

Covered or not separately reimbursable according to place of service and specific code combinations; items may be included in facility payments or considered integral to procedures.

Coverage determinations depend on place of service and relation to billed procedures; apply the rules below to determine separate reimbursement status.

Non‑facility integrated supplies

Non‑facility places of service include POS 1, 3, 4, 9, 11, 13, 14, 15, 16, 17, 20, 27, 33, 49, 50, 54, 55, 57, 60, 62, 65, 71, 72, 81 and 99.

Facility POS included in PPS

Facility places of service covered by this rule: POS 19, 21, 22, 23, and 24.
Costs for supplies, DME, orthotics, prosthetics, biologicals and drugs are deemed included in the facility Prospective Payment System (PPS) payment and are not separately reimbursable on a CMS‑1500.

Skilled nursing / nursing facility inclusion

Skilled nursing facility and nursing facility places of service: POS 31 and 32.

Implantable tissue markers and dosimeters

If A4648 or A4650 are reported in a facility setting or without CPT codes 19499, 32553, 49411, or 55876, they are not separately reimbursable.

Unclassified drug/biologic used as local anesthetic (POS 11): Local anesthetic agents submitted with J3490 or J3590 billed with procedures in the range 10000‑69999 in POS 11 are not separately reimbursable because the anesthetic agents are integral to the procedures.

Specific denied and non‑reimbursable codes

HCPCS A4570, A4580, A4590 (casting and splint supply codes) are not reimbursed; use temporary Q codes Q4001‑Q4051 to reimburse casting and splint supplies.
CPT codes 99070 and 99072 (non‑specific supply/material codes) are not reimbursable in any setting; an appropriate Level II HCPCS code must be submitted for covered supplies.
HCPCS L8680 (implantable neurostimulator electrode) is denied in all facility places of service and is also denied in non‑facility places of service when reported with CPT 63650 because the electrodes are considered included in the procedure reimbursement.

See attachments for code lists: Supply Facility J‑Code Denial Code List; Supply DME Codes in a Facility Setting; Supply Policy Code List; Supply DME Codes in a Skilled Nursing Facility for code‑specific lists.

Coding Guidance and Code Tables

Casting and splint supply codesHCPCSNot Covered

A4570	Casting and splint supply code — not reimbursed; invalid for Medicare
A4580	Casting and splint supply code — not reimbursed; invalid for Medicare
A4590	Casting and splint supply code — not reimbursed; invalid for Medicare
Q4001-Q4051	Temporary Q codes to reimburse casting and splint supplies (use these codes for reimbursement of casting/splint supplies)

Guidancemixed

No codes listed

Implantable markers/dosimetersHCPCS

A4648	Implantable tissue marker — separately billable with CPT codes 19499, 32553, 49411 or 55876 when billed on a physician services claim
A4650	Implantable radiation dosimeter — separately billable with CPT codes 19499, 32553, 49411 or 55876 when billed on a physician services claim

Associated CPT Codes (criteria)CPT

19499	Use with A4648/A4650 to allow separate reimbursement
32553	Use with A4648/A4650 to allow separate reimbursement
49411	Use with A4648/A4650 to allow separate reimbursement
55876	Use with A4648/A4650 to allow separate reimbursement

Unclassified drug/biologic codesHCPCSNot Covered

J3490	Unclassified drugs — local anesthetic agents billed with procedures in the range 10000-69999 in POS 11 are not separately reimbursable
J3590	Unclassified biologics — local anesthetic agents billed with procedures in the range 10000-69999 in POS 11 are not separately reimbursable

Specific denied/non-reimbursable codesmixedNot Covered

L8680	Implantable neurostimulator electrode — denied in all facility places of service and denied in non-facility POS when reported with CPT 63650
99070	Non-specific supply/material CPT code — not reimbursable in any setting
99072	Non-specific supply/material CPT code — not reimbursable in any setting

Associated CPT Code (criteria)CPT

63650

Percutaneous implantation of neurostimulator electrode array, epidural — reporting with L8680 results in denial in non-facility POS

Specific denied/non-reimbursable codesmixedNot Covered

L8680	Implantable neurostimulator electrode — denied in all facility places of service and denied in non-facility POS when reported with CPT 63650
99070	Non-specific supply/material CPT code — not reimbursable in any setting
99072	Non-specific supply/material CPT code — not reimbursable in any setting

Casting and splint related codes (reference)HCPCSNot Covered

A4570	Casting and splint supply code — not reimbursed; invalid for Medicare
A4580	Casting and splint supply code — not reimbursed; invalid for Medicare
A4590	Casting and splint supply code — not reimbursed; invalid for Medicare
Q4001-Q4051	Temporary Q codes to reimburse casting and splint supplies

Unclassified drug/biologic codes (reference)HCPCSNot Covered

J3490	Unclassified drugs — local anesthetic agents billed with procedures in the range 10000-69999 in POS 11 are not separately reimbursable
J3590	Unclassified biologics — local anesthetic agents billed with procedures in the range 10000-69999 in POS 11 are not separately reimbursable

Facility inclusion — supplies/drugs/DME

Facility POS included in facility PPSPOS 19, 21, 22, 23, 24 — supplies, DME, orthotics, prosthetics, biologicals and drugs are deemed included in the facility payment and not separately reimbursable on CMS-1500 when submitted by a physician or qualified professional.

Skilled nursing and nursing facility POSPOS 31 and 32 — payment for certain DME, orthotics, prosthetics and related supplies on the DMEPOS fee schedule is included in facility payment and not reimbursed separately on CMS-1500.

Code lists referenceSee UnitedHealthcare Supply Facility J‑Code Denial Code list and Supply DME Codes in a Facility Setting for specific codes not separately reimbursable in these facility POS.

Definitions and Place of Service Lists

Prospective Payment System (PPS)

DefinitionProspective Payment System (PPS) — a method of reimbursement in which payment is made based on a predetermined, fixed amount; payment amounts are derived from a classification system (e.g., DRGs) and CMS uses separate PPSs for various facility types.

Relation to facility payment inclusionUnder PPS, facility fixed rates deem all costs for supplies, DME, orthotics, prosthetics, biologicals and drugs included in the global facility payment; therefore UnitedHealthcare will not allow separate reimbursement on CMS-1500 for those items when billed from facility POS covered by PPS.

Scope of PPS examplesCMS uses separate PPSs for inpatient hospitals, hospital outpatient, skilled nursing facilities, home health agencies, hospice, inpatient rehab, LTCHs and others.

Non‑facility places of service (POS)

Non‑facility POS listPOS 1, 3, 4, 9, 11, 13, 14, 15, 16, 17, 20, 27, 33, 49, 50, 54, 55, 57, 60, 62, 65, 71, 72, 81, 99 — considered non‑facility places of service for this policy.

Claims Submission and Billing Actions

Documentation Required

Claims submission responsibility — CMS-1500 / electronic equivalent

You are responsible for submitting accurate claims using the CMS-1500 form (or its electronic equivalent). Use CPT, HCPCS, CMS and other coding guidance referenced by this policy and report the codes that correctly describe the services provided; UnitedHealthcare may apply reasonable discretion in interpreting and applying this policy.

Billing Rule

Do not separately bill supplies/DME/drugs by place of service

Do not seek separate reimbursement for HCPCS supply, DME, orthotic/prosthetic, biological or drug codes when those items are provided in specified facility places of service (POS 19, 21, 22, 23, 24, 31, 32) or when supplies are integral to an E/M service or procedure performed in non-facility POS; such costs are considered included in the facility Prospective Payment System (PPS) payment and are not separately reimbursable on a CMS-1500 claim.