CurrentUnitedHealthcarePolicy 2025R9026A

UnitedHealthcare Medicare Advantage Reimbursement Policy — CMS 1500: E/M (CPT 99202-99499)

Governs UnitedHealthcare Medicare Advantage reimbursement for E/M services billed on the CMS 1500 form, specifying which providers may report and be paid for CPT codes 99202-99499.

Policy Summary

PayerUnitedHealthcare

PolicyUnitedHealthcare Medicare Advantage Reimbursement Policy — CMS 1500: E/M services

Policy CodePolicy 2025R9026A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionSubmit accurate claims using the codes that correctly describe services; UnitedHealthcare may update this policy to align with CMS changes.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

99202-99499E/M CPT range

CMS 1500Claim form

NP, CNS, CNM, PAAllowed NPPs

Medicare AdvantageProducts

TOC, DefinitionsSections

E/M Reimbursement Criteria

E/M reimbursement criteria

Payment for E/M services (CPT 99202-99499) is limited to eligible providers as specified below.

UnitedHealthcare Medicare Advantage will pay for E/M services (CPT 99202-99499) only when reported by the eligible providers listed below.

Eligible billers

Physicians (Doctor of Medicine [MD] or Doctor of Osteopathy [DO]).
Nurse practitioners (NP) when they are allowed to bill for those services under applicable state and local law and payer rules.
Clinical nurse specialists (CNS) when they are allowed to bill for those services under applicable state and local law and payer rules.

Policy Summary

PayerUnitedHealthcare

PolicyUnitedHealthcare Medicare Advantage Reimbursement Policy — CMS 1500: E/M services

Policy CodePolicy 2025R9026A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionSubmit accurate claims using the codes that correctly describe services; UnitedHealthcare may update this policy to align with CMS changes.

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.

Codes and Allowed Reporters

E/M codesCPT

99202-99499

Evaluation and Management (E/M) services range

Allowed reporters for E/M codes — Coding (key facts)

Allowed reportersPhysicians; nurse practitioners (NP); clinical nurse specialists (CNS); certified nurse midwives (CNM); physician assistants (PA) when physician collaboration and general supervision rules are applied.

Excluded reportersNonphysician health care professionals not listed (i.e., other than NP, CNS, CNM, and PA where applicable) are not reimbursed for E/M codes (CPT 99202-99499).

Applicable CPT rangeEvaluation and Management services CPT codes 99202-99499.

Claims Submission and Policy Updates

Billing Rule

Claims Submission and Policy Updates — Provider Responsibilities

You are responsible for submitting accurate claims using the code or codes that correctly describe the health care services provided. UnitedHealthcare Medicare Advantage reimbursement policies use CPT, CMS, and other coding guidelines; references are for definitional purposes and do not assure reimbursement. Submit services on CMS 1500 forms and follow CPT/CMS/NCCI guidance to report the most comprehensive and appropriate code for the service performed. E/M codes (CPT 99202-99499) should be reported only by physicians or eligible nonphysician practitioners (NP, CNS, CNM, and PA where state law and supervision/collaboration rules permit). UnitedHealthcare Medicare Advantage will not reimburse E/M services (99202-99499) when reported by nonphysician professionals not listed above.

Affected codes: CPT 99202-99499 (E/M services)
Claims form: CMS 1500
Key provider types allowed to report E/M: Physicians (MD/DO), Nurse Practitioners (NP), Clinical Nurse Specialists (CNS), Certified Nurse Midwives (CNM), Physician Assistants (PA) when state law and supervision/collaboration rules permit

Key Definitions

Physician — Definition (key facts)

DefinitionPhysician: Doctor of Medicine (MD) or Doctor of Osteopathy (DO).

Scope notePhysicians are authorized to report E/M services (CPT 99202-99499) per CPT guidance referenced in this policy.

Policy contextUnitedHealthcare Medicare Advantage will pay for E/M services reported by Physicians when services meet coding and documentation requirements.

Nonphysician Practitioners (NPP) — Definition (key facts)

DefinitionNonphysician Practitioners (NPP): physician assistants (PA), clinical nurse specialists (CNS), certified nurse midwives (CNM), and nurse practitioners (NP).

Condition of practiceNPPs may provide, certify, or supervise services if state and local laws permit and appropriate rules are followed.

Billing conditionsNP, CNS, and CNM will be paid for E/M services when allowed to bill; PAs are allowed when physician collaboration and general supervision rules are applied.