CurrentUnitedHealthcarePolicy 2024R9065A

Hospital inclusive charges (UB04) reimbursement

Defines UnitedHealthcare Medicare Advantage reimbursement stance that routine services, supplies, nursing care, and certain equipment are included in room/board or procedure charges and are not separately reimbursable for facilities.

Policy Summary

PayerUnitedHealthcare

PolicyHospital inclusive charges (UB04) reimbursement

Policy CodePolicy 2024R9065A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionFacilities should expect documentation requests and itemized bill reviews/audits as part of standard process to ensure reimbursements comply with policy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

listsexamples provided

1/dayVentilator/CPAP

Bundled Charges and Non-Separately Reimbursable Items

Bundled items and services

Items and services incorporated into room/board, facility, or surgical suite charges (not separately reimbursable):

ALL of the following

Policy Summary

PayerUnitedHealthcare

PolicyHospital inclusive charges (UB04) reimbursement

Policy CodePolicy 2024R9065A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionFacilities should expect documentation requests and itemized bill reviews/audits as part of standard process to ensure reimbursements comply with policy.

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.

Nursing and related bedside services

Nursing care/services performed by primary bedside nurses (RN/LPN), respiratory therapists, certified nursing assistants, perfusionists or other technicians as part of their daily responsibilities are included in room and board and not separately reimbursable; examples include medication administration, IV access and maintenance, monitoring (vital signs, cardiac), tracheostomy care, urinary catheterization, venipuncture, respiratory treatments.

Surgical room items and operating suite charges

Charges for surgical suites and service areas (including major/minor surgical suites, treatment rooms, endoscopy, cath labs, procedural rooms) include the full range of nursing personnel services, supplies, and equipment; specific examples include anesthesia equipment, monitors and gases, intubation/extubation items, cardiac monitors, cardiopulmonary bypass equipment, grounding pads, laparoscopes/bronchoscopes/endoscopes and accessories, surgeons' loupes, batteries, and related items which are incorporated into the surgical room/service charge.

ALL of the following

Examples by revenue code
- Items associated with revenue codes 260-269, 270, 279, 410, 412 (examples: sterile supplies, perfusion equipment, pumps, machines such as anesthesia, bladder scanner, CPAP, fetal monitors) are included in bundled reimbursement.
- Items associated with revenue codes 250, 270-279 (examples: medical/surgical supplies such as bandages, IV solutions, oxygen supplies, thermometers, specimen collection kits) are included in bundled reimbursement.

Relevant Revenue Codes

Revenue code examplesmixedCovered

260-269	Examples of revenue codes associated with supplies, equipment, pumps and related items incorporated into room/procedure reimbursement
270	Examples of revenue codes associated with supplies, equipment, pumps and related items incorporated into room/procedure reimbursement
279	Examples of revenue codes associated with supplies, equipment, pumps and related items incorporated into room/procedure reimbursement
410	Examples of revenue codes associated with supplies, equipment, pumps and related items incorporated into room/procedure reimbursement
412	Examples of revenue codes associated with supplies, equipment, pumps and related items incorporated into room/procedure reimbursement
250	Medical/surgical supplies examples included in bundled reimbursement

Documentation, Audits, and Billing Expectations

Documentation Required

Expect documentation requests and itemized bill reviews/audits

Facilities should expect documentation requests and itemized bill reviews and hospital bill audits as part of UnitedHealthcare’s standard process to ensure reimbursements comply with this policy.

Documentation requests are used in reviews and audits of claims paid on a percent-of-charge basis.
Itemized bill reviews and hospital bill audits may be performed to verify that items were appropriately included in room/board or procedure reimbursement.

Definitions: Routine Services and Supplies

Routine services — definition and examples

DefinitionRoutine services: regular room/observation room costs, dietary and nursing services, minor medical and surgical supplies, medical and psychiatric social services, and the use of certain equipment and facilities without a separate charge.

Inclusion in chargesRoutine services are incorporated into room and board, facility, or ancillary service charges (including standard rooms and special care units such as CCU/ICU) and are not separately reimbursable.

ScopeRoutine aspects of ancillary services (even if ancillary services may be reimbursed) are bundled and not separately billable.

ExamplesDietary and nursing services, minor medical/surgical supplies, medical/psychiatric social services, use of certain equipment and facilities.

Policy basisUnitedHealthcare incorporates CMS Provider Reimbursement Manual definition of routine services to define bundling and non‑reimbursability.

Routine supplies / floor stock — definition and examples

DefinitionRoutine supplies / floor stock: items generally available to all patients that are incorporated into the procedure or facility reimbursement and are not separately reimbursable.

Inclusion in chargesRoutine medical equipment and supplies considered floor stock are included in the reimbursement for the procedure or facility charge and cannot be billed separately.

Typical itemsMinor medical/surgical supplies that are routinely stocked for patient care (examples: bandages, basic disposables, common monitoring accessories).

RationaleThese items are included because they are routinely used across patients and facilities and form part of the bundled room/board or ancillary reimbursement.

Policy referenceUnitedHealthcare follows CMS Provider Reimbursement Manual guidance that routine supplies are incorporated into overall facility/procedure reimbursement.