CurrentUnitedHealthcarePolicy 2025R0126A

Reporting and reimbursement of pediatric and neonatal critical and intensive care codes (CPT 99468-99476, 99477-99480) on CMS 1500

Defines UnitedHealthcare's reimbursement approach for pediatric and neonatal critical and/or intensive care CPT codes when billed on CMS 1500 forms, including when such codes are reported on the same day with other procedure or E/M services by physicians or other qualified health care professionals in the same group.

Policy Summary

PayerUnitedHealthcare

PolicyReporting and reimbursement of pediatric and neonatal critical and intensive care codes (CPT 99468-99476, 99477-99480) on CMS 1500

Policy CodePolicy 2025R0126A

Change TypePolicy verbiage and template updates

Effective Date

Next Review Date

Key ActionWhen these pediatric/neonatal critical or intensive care codes are billed the same day with other services by the same group, follow CPT reporting instructions and, where CPT is silent, apply CMS NCCI edits to determine if a modifier override is appropriate; ensure claims include the Federal Tax Identification number to establish 'Same Group' relationships.

SourceLink

POLICY UPDATE CHANGES

Policy verbiage update effective 2025-07-21.

Template update effective 2024-04-01 transferring content to shared policy template and clarifying application to benefit plans.

History section cleaned up on 2023-08-25 removing dates prior to 2021-08-25.

99468-99480Primary codes addressed

59,XE,XS,XUModifiers referenced

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