CurrentUnitedHealthcarePolicy N/A

List of CPT/HCPCS codes by service category (Coding reference section)

This document section lists procedure and billing codes grouped by service category (Preventive, Problem-oriented E/M, Other E/M, Screening, Prolonged, Counseling, Medical Nutrition Therapy, Visual Function) relevant to UnitedHealthcare reimbursement/payment policy.

Policy Summary

PayerUnitedHealthcare

PolicyList of CPT/HCPCS codes by service category (Coding reference section)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionUse the listed service code groups when reporting preventive, E/M, screening, prolonged, counseling, MNT and visual function services for reimbursement consideration.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

7service code categories listed

~80individual CPT/HCPCS codes enumerated

Historydocument history notes present

Code Groups by Service Category

Code Groups

Listed codes correspond to service categories referenced by the policy.

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CPT / HCPCS Codes by Category

Counseling / Preventive / Screening / Behavioral Health CodesmixedCovered

0403T	Screening/assessment code (technology-based)
90482	Immunization administration by pharmacist, single or combination vaccine, first vaccine dose
90483	Immunization administration by pharmacist, single or combination vaccine, additional vaccine dose
90484	Immunization administration by pharmacist, single or combination vaccine, each additional vaccine dose
99401	Preventive medicine counseling, 15 minutes
99402	Preventive medicine counseling, 30 minutes
99403	Preventive medicine counseling, 45 minutes
99404	Preventive medicine counseling, 60 minutes
99406	Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
99407	Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes

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Preventive Medicine Service CodesCPTCovered

99381	Initial comprehensive preventive medicine, infant
99382	Initial comprehensive preventive medicine, early childhood
99383	Initial comprehensive preventive medicine, late childhood
99384	Initial comprehensive preventive medicine, adolescent
99385	Initial comprehensive preventive medicine, adult 18-39
99386	Initial comprehensive preventive medicine, adult 40-64
99387	Initial comprehensive preventive medicine, adult 65+
99391	Periodic comprehensive preventive medicine, infant
99392	Periodic comprehensive preventive medicine, early childhood
99393	Periodic comprehensive preventive medicine, late childhood

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Problem-oriented Evaluation & Management CodesCPTCovered

99202	Office/outpatient visit new patient, typically 20 minutes
99203	Office/outpatient visit new patient, typically 30 minutes
99204	Office/outpatient visit new patient, typically 45 minutes
99205	Office/outpatient visit new patient, typically 60 minutes
99212	Office/outpatient visit established patient, typically 10 minutes
99213	Office/outpatient visit established patient, typically 15 minutes
99214	Office/outpatient visit established patient, typically 25 minutes
99215	Office/outpatient visit established patient, typically 40 minutes
G0463	Hospital outpatient clinic visit, new or established patient

Other E/M and Facility CodesmixedCovered

99211	Office or other outpatient visit, established patient, usually 5 minutes
99242	Consultation, outpatient, typically 30 minutes
99243	Consultation, outpatient, typically 40 minutes
99244	Consultation, outpatient, typically 60 minutes
99245	Consultation, outpatient, typically 40-60 minutes
99252	Inpatient consultation by physician, typically 20 minutes
99253	Inpatient consultation by physician, typically 40 minutes
99254	Inpatient consultation by physician, typically 60 minutes
99255	Inpatient consultation by physician, typically comprehensive
99281	Emergency department visit, problem-focused

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Screening Services CodesHCPCSCovered

G0101	Cervical cancer screening; pelvic and clinical breast exam
G0102	Prostate cancer screening; digital rectal exam
Q0091	Screening Papanicolaou test

Prolonged Services CodesmixedCovered

99415	Prolonged physician services in the inpatient or observation setting; first hour
99416	Prolonged physician services in the inpatient or observation setting; each additional 30 minutes
99417	Prolonged office or other outpatient evaluation and management service(s) rendered beyond the total time of the primary service
99418	Prolonged services in the inpatient setting, per additional 30 minutes
G0316	Prolonged preventive services, first hour
G0317	Prolonged preventive services, each additional 30 minutes
G0318	Prolonged preventive services, miscellaneous
G2212	Prolonged E/M services on the same date as the primary E/M service

Medical Nutrition Therapy & Visual Function CodesmixedCovered

97802	Medical nutrition therapy; assessment and intervention, individual, first 15 minutes
97803	Medical nutrition therapy; reassessment and intervention, individual, first 15 minutes
97804	Medical nutrition therapy, group session
G0270	Medical nutrition therapy, initial, assessment and intervention
G0271	Medical nutrition therapy, reassessment and intervention
99172	Eye and vision screening by a physician or qualified health care professional
0333T	Instrument-based vision/visual function test

Provider-Facing Code Lists and Billing Highlights

Billing Rule

Problem-Oriented E/M Service Codes

Problem-oriented evaluation and management (E/M) codes for outpatient visits. Submit the appropriate code that reflects the documented history, exam, and medical decision making (or time when using time-based coding). Ensure documentation supports the selected level of service.

99202 - Office or other outpatient visit for the evaluation and management of a new patient, typically 15-29 minutes
99203 - new patient, typically 30-44 minutes
99204 - new patient, typically 45-59 minutes
99205 - new patient, typically 60-74 minutes
99212 - Office or other outpatient visit for the evaluation and management of an established patient, typically 10-19 minutes
99213 - established patient, typically 20-29 minutes
99214 - established patient, typically 30-39 minutes
99215 - established patient, typically 40-54 minutes
G0463 - Hospital outpatient clinic visit for assessment and management of a patient (when applicable)

Billing Rule

MNT and Visual Function Codes

Medical nutrition therapy (MNT) and visual function/acuity screening codes. Bill the MNT code that matches the service (initial vs follow-up, individual vs group) and include any required diagnosis or referral per contract. For visual function/acuity screening, document screening results and any follow-up plan.

97802 - MNT; initial assessment and intervention, individual, face-to-face, 15 minutes
97803 - MNT; re-assessment and intervention, individual, face-to-face, 15 minutes
97804 - MNT; group (2 or more), each 30 minutes
G0270 - Professional nutrition therapy/assessment, typically used in some settings
G0271 - Follow-up nutrition therapy/education
99172 - Visual acuity screening
0333T - Visual function screening, professional service

OpenPayer

List of CPT/HCPCS codes by service category (Coding reference section)

Code Groups by Service Category

CPT / HCPCS Codes by Category

Provider-Facing Code Lists and Billing Highlights

Reference Resources

Document History