CMS-1500 billing for nonphysician inpatient services (perfusionist codes)
This policy governs UnitedHealthcare Medicare Advantage reimbursement for nonphysician services billed on the CMS-1500 form for inpatient settings, specifying that certain perfusionist CPT codes are not separately reimbursable and must be billed by the hospital. It affects providers submitting Medicare Advantage claims.
No material clinical or coverage changes in this revision.
Inpatient Nonphysician Services Billing Criteria
Inpatient nonphysician services billing criteria
UnitedHealthcare Medicare Advantage does not allow separate reimbursement for the following nonphysician inpatient services when billed on a CMS-1500; they must be provided directly by the hospital or billed through the hospital.
Inpatient-only perfusionist services
- Perfusionist services reported with CPT codes 99190, 99191, 99192 are considered inpatient-only and are not separately reimbursable.
- These CPT codes have OPPS status indicator 'C' and are listed as inpatient-only in OPPS Addendum B/Addendum E; there is no separate OPPS payment for these services.
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.