From-To (Grouping) Claim Submission/Reimbursement Policy
Governance of how services reported with 'from' and 'to' dates and units on the CMS-1500 (and electronic equivalent) are processed for UnitedHealthcare Community Plan Medicaid products; explains grouping rules, exceptions, and state-specific variances.
Multiple Attachment and State Exceptions sections were updated on various dates (e.g., 6/29/2025, 3/30/2025, 3/9/2025, 1/1/2025, 11/17/2024, 10/13/2024, 9/22/2024, 6/30/2024, 6/14/2024, 3/31/2024, 2/22/2026, 1/1/2026, 9/21/2025, 7/20/2025, 7/13/2025).
Colorado was added to the State Exceptions section.
Rhode Island was added to the State Exceptions section.
From–To Units and Exceptions
From-To Units correspondence and exceptions
Reimbursement will be considered only when from/to date spans greater than one day have units that correspond to or are equally divisible by the number of days indicated.
Exceptions (one of)
- CPT/HCPCS codes whose descriptions indicate reporting 'per week', 'per month', or 'per course of treatment' may be reported with a 'from' and 'to' date and are exempt.
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