CurrentUnitedHealthcarePolicy 2026R0006C

CMS 1500 Supply and HCPCS Reimbursement Policy

Defines UnitedHealthcare's reimbursement methodology and billing rules for supplies, DME, orthotics, prosthetics, biologicals and drugs reported on the CMS-1500 form (and electronic equivalent) across Commercial and Individual Exchange plans; affects physicians and other qualified health care professionals submitting CMS-1500 claims.

Policy Summary

PayerUnitedHealthcare

PolicyCMS 1500 Supply and HCPCS Reimbursement Policy

Policy CodePolicy 2026R0006C

Change TypeNo material change

Effective Date

Next Review Date

Key ActionSubmit accurate CMS-1500 claims using correct codes and follow coding guidelines; do not expect separate reimbursement for specified supplies/DME when policy indicates inclusion in procedure or facility payment.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

CMS-1500claim form governed

19,21,22,23,24facility POS not reimbursed

31,32SNF/NF POS

99070/99072non-specific supply codes denied

non-facility POSnon-facility POS list

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Separate Reimbursement Criteria

Separate reimbursement criteria

UnitedHealthcare will not separately reimburse specified HCPCS supply and DME codes when they are considered included in E/M or procedure services, or when included in facility/global payments. The specific inclusion and exclusion rules are listed below.

ALL of the following

Non-facility inclusion: HCPCS supply codes that are considered included in an Evaluation and Management (E/M) service or procedure provided the same day in a non-facility place of service will not be separately reimbursed.
Non-facility POS list: 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.
Facility inclusion (POS 19,21,22,23,24): When services are provided in facility places of service 19, 21, 22, 23 or 24, supplies, DME, orthotics, prosthetics, biologicals and drugs are considered included in the facility's global payment and are not separately reimbursable on a CMS-1500 claim.
SNF/NF inclusion (POS 31,32): For skilled nursing facility (POS 31) and nursing facility (POS 32), payment for certain DME, orthotics, prosthetics and related supplies is included in the facility payment and not separately reimbursable on CMS-1500 claims.

ALL of the following

Implantable markers/dosimeters exception: HCPCS A4648 (implantable tissue marker) and A4650 (implantable radiation dosimeter) are separately billable and payable when billed with CPT codes 19499, 32553, 49411 or 55876 on a physician services claim; otherwise they are subject to the inclusion rules and are not separately reimbursable, including in facility settings.
Casting and splint supplies: HCPCS A4570, A4580 and A4590 are invalid for Medicare use; use temporary Q-codes Q4001–Q4051 for casting and splint supplies consistent with CMS guidance.
J-codes with procedures in POS 11: Local anesthetic agents submitted with J3490 or J3590 when billed with procedures in the range 10000–69999 in POS 11 are not separately reimbursable because the agents are integral to the procedures.
Non-specific supply codes not reimbursable: CPT codes 99070 and 99072 are not reimbursable in any setting; an appropriate Level II HCPCS code must be submitted for covered medical and surgical supplies.

Code Lists and Place-of-Service Rules

Casting and splint suppliesHCPCS

A4570	Casting/splint supply (invalid for Medicare use)
A4580	Casting/splint supply (invalid for Medicare use)
A4590	Casting/splint supply (invalid for Medicare use)
Q4001-Q4051	Temporary Q-codes for casting/splint supplies

Implantable markers/dosimetersmixedCovered

A4648	Implantable tissue marker - separately billable with specified CPTs
A4650	Implantable radiation dosimeter - separately billable with specified CPTs
19499	Unlisted procedure - breast (example CPT listed in policy)
32553	Placement of marker (example CPT listed in policy)
49411	Insertion of implantable marker (example CPT listed in policy)
55876	Placement related CPT listed in policy

Miscellaneous codes with reimbursement rulesmixedNot Covered

J3490	Unclassified drugs - local anesthetic agents not separately reimbursable in POS 11 when billed with procedures 10000-69999
J3590	Unclassified biologics - same restriction as J3490
99070	Supplies and materials - not reimbursable
99072	Environmental services - not reimbursable

Neurostimulator electrodemixedNot Covered

L8680	Implantable neurostimulator electrode - denied in facility POS and when reported with CPT 63650 in non-facility
63650	Percutaneous implantation of neurostimulator electrode array, epidural

inv-06: Facility inclusion — when billed on CMS-1500 in facility POS (19,21,22,23,24) and SNF/NF POS (31,32), many supplies/DME/drugs are included in facility/global payment and not separately reimbursable.

When billed in facility POSWhen a physician or other qualified health care professional submits a CMS-1500 claim from a facility place of service (POS 19, 21, 22, 23, 24), specified supplies, DME, orthotics, prosthetics, biologicals and drugs are considered included in the facility's global payment and are not separately reimbursable.

Applicable facility POS listPOS 19, 21, 22, 23, 24 are defined as facility places of service where separate reimbursement is not allowed for listed items.

SNF/NF inclusionFor skilled nursing facility and nursing facility (POS 31 and 32), payment for certain DME, orthotics, prosthetics and related supplies is included in the facility payment and not separately reimbursable when reported on CMS-1500.

Reference to denial listsUnitedHealthcare maintains Supply Facility J-Code Denial Code List and Supply DME Codes in a Facility Setting that enumerate codes not separately reimbursable in facility settings.

Claims Submission and Billing Guidance

Documentation Required

Claims submission responsibility

You are responsible for submission of accurate claims on the CMS-1500 form (or its electronic equivalent). Use codes that correctly describe the services provided and follow applicable CPT, CMS and other coding guidelines; UnitedHealthcare may exercise reasonable discretion in interpreting and applying this policy.

Billing Rule

Separate reimbursement restrictions for supplies/DME/drugs

Do not expect separate reimbursement for specified HCPCS supplies, DME, orthotics, prosthetics, biologicals and drugs when those items are considered included in facility or certain non‑facility payments; UnitedHealthcare will not allow separate reimbursement when submitted on a CMS-1500 claim form in the listed places of service.

Supplies provided the same day as an E/M service or procedure in non‑facility POS (POS 1,3,4,9,11,13,14,15,16,17,20,27,33,49,50,54,55,57,60,62,65,71,72,81,99) are not separately reimbursable (costs considered part of the E/M or procedure).

Place-of-Service and Payment Terms

inv-09: Prospective Payment System (PPS) — definition/mention relevant to facility/global payments.

DefinitionProspective Payment System (PPS) is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount; under PPS all costs associated with supplies, DME, orthotics, prosthetics, biologicals and drugs are deemed included in the global facility payment.

CMS use of PPSCMS uses separate PPSs for various settings (hospital inpatient, hospital outpatient, SNF, etc.), and UnitedHealthcare aligns facility inclusion rules with CMS PPS methodology.

Implication for CMS-1500 claimsBecause PPS rates are fixed, items included in the facility payment are not separately reimbursable when billed on CMS-1500 by a physician or other qualified health care professional.

inv-10: Non-facility POS — list of POS codes considered non-facility where separate reimbursement may apply.

Non-facility POS listNon-facility places of service considered by this policy: 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.

Policy Summary

PayerUnitedHealthcare

PolicyCMS 1500 Supply and HCPCS Reimbursement Policy

Policy CodePolicy 2026R0006C

Change TypeNo material change

Effective Date

Next Review Date

SourceLink

On This Page

Neurostimulator electrode: HCPCS L8680 (implantable neurostimulator electrode) is denied in all facility places of service because it is considered included in the facility reimbursement; L8680 is also denied in non-facility when reported with CPT 63650 because the electrodes are included in the procedure reimbursement.

In facility POS 19,21,22,23,24, supplies, DME, orthotics, prosthetics, biologicals and drugs are included in the facility global payment and are not separately reimbursable on CMS-1500 claims.

In skilled nursing facility and nursing facility POS 31 and 32, certain DME, orthotics, prosthetics and related supplies on the DMEPOS fee schedule are included in facility payment and not separately reimbursable.

Inclusion rule for non-facilityCertain HCPCS supply codes are not separately reimbursable when provided the same day as an E/M service or procedure performed in a non-facility POS by a physician or other qualified health care professional.

Claim form applicabilityRules apply when supplies are billed on the CMS-1500 or electronic equivalent by physicians or other qualified health care professionals in non-facility POS.

inv-11: Facility POS — POS 19,21,22,23,24 where facility payment is global and supplies/drugs are included.

Facility POS definedFacility places of service per policy: POS 19, 21, 22, 23, 24.

Inclusion of supplies/drugsWith CMS PPS fixed facility rates, all costs associated with supplies, DME, orthotics, prosthetics, biologicals and drugs are deemed included in the facility global payment and are not separately reimbursable on CMS-1500 claims.

Supporting resourcesUnitedHealthcare provides a Supply Facility J-Code Denial Code list and Supply DME Codes in a Facility Setting that enumerate codes not separately reimbursable in these POS.

inv-12: SNF/NF POS — Skilled nursing facility and nursing facility POS 31 and 32; certain DME and supplies are included in payment.

SNF/NF POS definedSkilled nursing facility and nursing facility places of service are POS 31 and 32.

Included itemsUnitedHealthcare considers payment for certain DME, orthotics, prosthetics and related supplies on the CMS DMEPOS fee schedule to be included in payment to SNF (POS 31) and NF (POS 32) and not separately reimbursable when reported on CMS-1500.

Alignment with CMS PPSThis treatment aligns with the CMS Prospective Payment System reimbursement methodology for skilled nursing and nursing facility settings.