CurrentUnitedHealthcarePolicy 2025R9O67A

Reimbursement for home health services during inpatient stay

Governs UnitedHealthcare Medicare Advantage reimbursement for home health services billed on UB-04 or CMS‑1500 (POS 12) when the member has overlapping inpatient care; affects providers billing Medicare Advantage plans.

Policy Summary

PayerUnitedHealthcare

PolicyReimbursement for home health services during inpatient stay

Policy CodePolicy 2025R9O67A

Change TypePolicy Version ChangeNew policy implemented 10/1/2024

Effective Date

Next Review Date

Key ActionSubmit accurate claims using CPT and CMS coding guidelines with POS 12 on CMS‑1500 or the specified UB‑04 bill types.

SourceLink

POLICY UPDATE CHANGES

7/1/2025 = Policy Version Change.

10/1/2024 = New Policy Implemented by UnitedHealthcare Medicare Advantage.

UB-04/CMS-1500claim forms addressed

POS 12place of service

321-329,341-345,347-349UB-04 bill types

inpatient daysinpatient days excluded

Coverage Criteria for Home Health During Inpatient Stay

Home health during inpatient stay criteria

UnitedHealthcare will not reimburse home health services billed for dates that overlap with an inpatient stay, with specified exceptions and billing requirements.

If home health services and inpatient care are billed for the same dates of service, UnitedHealthcare will reimburse the inpatient care only; home health services for those overlapping dates are not eligible for reimbursement.

Exceptions

Home health services provided on the dates of inpatient admission may still be eligible for reimbursement.
Home health services provided on the dates of inpatient discharge may still be eligible for reimbursement.

Home health services must be submitted with POS 12 on a CMS-1500 claim form or using UB-04 bill types 321-329, 341-345, or 347-349 to be considered under this policy (these indicate services provided in a private residence).

Policy Summary

PayerUnitedHealthcare

PolicyReimbursement for home health services during inpatient stay

Policy CodePolicy 2025R9O67A

Change TypePolicy Version ChangeNew policy implemented 10/1/2024

Effective Date

Next Review Date

Key ActionSubmit accurate claims using CPT and CMS coding guidelines with POS 12 on CMS‑1500 or the specified UB‑04 bill types.

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.

Place of Service Codes, Bill Types, and Reimbursement Exclusions

Home health service location codes and bill typesmixed

POS 12	Home — Place of Service code for services provided in a private residence
UB-04 bill types 321-329, 341-345, 347-349	Home health bill types indicating services provided in private residence

Reimbursement exclusion during inpatient stay

Policy exclusionIf home health services (POS 12 on CMS‑1500 or UB‑04 bill types 321-329, 341-345, 347-349) and inpatient care are billed for the same dates, UnitedHealthcare will reimburse inpatient care only; home health services for those dates are not eligible for reimbursement.

ExceptionHome health services provided on the dates of inpatient admission and discharge may still be eligible for reimbursement.

Claim form requirementHome health services must be submitted with POS 12 on CMS‑1500 or type of bill 321-329, 341-345, or 347-349 on UB‑04 to be considered under this policy.

ReasoningPolicy aligns with CMS practice to avoid duplicate reimbursement when inpatient care overlaps with home health services.

Claims Submission and Billing Guidance

Documentation Required

Claims submission and coding guidance

You are responsible for submission of accurate claims using Current Procedural Terminology (CPT), Centers for Medicare and Medicaid Services (CMS), or other coding guidelines; UnitedHealthcare Medicare Advantage reimbursement policies use these coding sources to determine reimbursement. This policy does not include notations regarding authorization requirements.

Submit claims on the appropriate form (UB-04/CMS 1450 or CMS 1500) using the codes that correctly describe the services provided.
Follow CPT, CMS, and other industry-standard coding guidelines; references are for definitional purposes and do not guarantee reimbursement.
UnitedHealthcare Medicare Advantage reimbursement policies do not include authorization requirement notations.

Definitions

Durable Medical Equipment (DME)

DefinitionDurable Medical Equipment (DME): Medical equipment which can withstand repeated use, is not disposable, is used to serve a medical purpose, is generally not useful in the absence of sickness or injury, and is appropriate for use in the home.

Characteristic - reuseCan withstand repeated use (durability).

Characteristic - non-disposableNot intended for single-use or disposable.

Characteristic - medical purposeUsed to serve a medical purpose and typically prescribed to treat or manage a condition.

Place of Service

DefinitionPlace of Service (POS): A two-digit code used on health care professional (CMS‑1500) claims to indicate the setting in which a service was provided.

Example relevant to policyPOS 12 denotes services provided in a private residence (home health).

Use on claimsPOS codes must be reported on professional claims to identify the service setting for reimbursement determination.