CurrentUnitedHealthcarePolicy N/A

Procedure-to-Place-of-Service reimbursement policy

Defines allowable places of service (POS) for CPT and HCPCS procedure codes for UnitedHealthcare Community Plan Medicaid products and explains that state-specific exceptions may modify POS allowances; applies to services billed on CMS-1500 (and where specified UB04) for network and non-network providers.

Policy Summary

PayerUnitedHealthcare

PolicyProcedure-to-Place-of-Service reimbursement policy

Policy CodePolicy N/A

Change TypeAdministrative changelog / state exception updates

Effective DateN/A

Next Review DateN/A

Key ActionProviders must submit accurate claims using CPT/HCPCS codes and the appropriate place of service on the CMS-1500 (or electronic equivalent).

SourceLink

POLICY UPDATE CHANGES

Multiple entries update the State Exceptions and Attachments (Medicaid Procedure to Place of Service List; Arizona Procedure to Place of Service List) across various states.

Several states were added or updated in the State Exceptions section (examples include New Mexico, Missouri, Indiana, New Jersey).

multipleattachments referenced

manystates with updates

CMS-1500claim form applicability

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Place-of-Service Coverage Criteria

Place-of-Service coverage criteria

UnitedHealthcare Community Plan maintains a list mapping CPT and HCPCS procedure codes to allowable places of service for Medicaid products; attachments provide detailed lists and state-specific lists exist where noted.

Codes should be billed with a place of service (POS) consistent with the CPT/HCPCS code description; e.g., do not bill inpatient POS for a code described as an office or outpatient visit.

UnitedHealthcare Community Plan has established a list of CPT and HCPCS codes with their appropriate allowable places of service.

If a code is not on UnitedHealthcare Community Plan's list, the place of service is not limited (default: no payer-imposed POS limitation).

Allowable POS for Medicaid products are detailed in attachments (for example: 'Medicaid Procedure_to Place of Service List').

State-specific exceptions may modify allowable POS for certain codes; state attachments include lists such as the 'Arizona Procedure_to Place of Service List' and other state lists (for example, a Washington reentry program list allowing POS 09 for certain codes).

Administrative changelog

This section records administrative updates and attachment/state list revisions; no clinical coverage criteria are described in these entries.

Changelog entries record policy version changes, state exceptions updates, and attachment revisions (examples include multiple dated entries from 2012 through 2025 listing state and attachment updates).

These changelog lines do not introduce clinical coverage criteria or modify clinical stance; they document administrative and state-specific list maintenance only.

Code Systems and Coding Rules

Code systems referencedmixed

CPT	Current Procedural Terminology codes referenced for POS guidance
HCPCS	HCPCS procedure codes referenced for POS guidance

No codes in this sectionmixed

No codes listed

Default rule when code not listed

Default ruleIf a CPT or HCPCS code is not on UnitedHealthcare Community Plan's established code-to-POS list, there is no payer-imposed place-of-service limitation (place of service not limited).

ScopeApplies to CPT and HCPCS procedure codes covered by this policy.

Implication for billingProviders may bill any appropriate POS for codes not listed on the payer's mapping; other reimbursement policies may still apply.

Not applicable — coding thresholds

Thresholds providedNo coding thresholds, numeric limits, or POS limits are specified in these policy chunks.

Changelog context

Provider Billing and Submission Responsibilities

Billing Rule

Submit Accurate Claims and Coding

Providers are responsible for submitting accurate claims using correct CPT/HCPCS codes and the appropriate place of service. This policy applies to services billed on the CMS-1500 form (and where specified, UB-04). Ensure coding and claim form selection reflect the services rendered to avoid claim denials or reimbursement adjustments.

Use current CPT/CMS/HCPCS coding guidelines when reporting services.
Bill services on CMS-1500 (or electronic equivalent); follow UB-04 guidance where specified.
Ensure Place of Service (POS) codes accurately reflect the setting where services were provided.
UnitedHealthcare may interpret and apply policy using discretion; external factors (state/federal rules, provider contracts, member benefits) may alter reimbursement.

Note

Changelog — State Exceptions & Attachments

Definitions and Attachments

Place of Service (POS)

DefinitionPlace of Service (POS) — the location where health care services are furnished as indicated by CPT and HCPCS code descriptions.

Use in policyPolicy assigns allowable POS to CPT and HCPCS codes using code descriptions and maintained code-to-POS lists.

Billing noteAn inappropriate POS (e.g., inpatient for a code described as office or outpatient) is not appropriate and may affect reimbursement.

CMS-1500 (Health Insurance Claim Form)

Form nameCMS-1500 — Health Insurance Claim Form used to bill services under this reimbursement policy.

ApplicabilityPolicy applies to services billed on CMS-1500 forms and, when specified, to those billed on UB04 forms.

7/13/2025 — State Exceptions: California Removed; Texas Updated. History: Entries prior to 7/13/2023 archived.
6/29/2025 — State Exceptions: Missouri Updated. Attachment: Medicaid Procedure to Place of Service List updated. History: Entries prior to 6/29/2023 archived.
6/22/2025 — State Exceptions: Washington Updated. History: Entries prior to 6/22/2023 archived.
5/25/2025 — State Exceptions: Kentucky Updated. History: Entries prior to 5/25/2023 archived.
4/13/2025 — State Exceptions: Kansas Updated. History: Entries prior to 4/13/2023 archived.
4/4/2025 — State Exceptions: New Jersey Updated. History: Entries prior to 4/4/2023 archived.
3/30/2025 — State Exceptions: Kansas Updated. Attachment: Medicaid Procedure to Place of Service List updated. History: Entries prior to 3/30/2023 archived.
2/27/2025 — State Exceptions: Tennessee Updated. History: Entries prior to 2/27/2023 archived.
2/16/2025 — State Exceptions: Texas Updated. History: Entries prior to 2/16/2023 archived.
2/9/2025 — State Exceptions: Kansas & Washington Updated. History: Entries prior to 2/9/2023 archived.
1/26/2025 — State Exceptions: Florida Updated. History: Entries prior to 1/26/2023 archived.
1/19/2025 — State Exceptions: Texas Updated. History: Entries prior to 1/19/2023 archived.
11/3/2024 — State Exceptions: Minnesota and Texas Updated. History: Entries prior to 11/3/2022 archived.
10/13/2024 — State Exceptions: Kansas and Texas Updated.
10/6/2024 — Attachments: Medicaid Procedure to Place of Service List updated. State Exceptions: Kansas Updated.