CurrentUnitedHealthcarePolicy 2025R6011A

Same Day Medical Visits and Trauma Activation Reimbursement (UB04)

Governs UnitedHealthcare reimbursement for UB04 claims when outpatient medical visit E/M codes are submitted with other procedures on the same day, and for billing trauma activation in conjunction with critical care services; applies to UnitedHealthcare Commercial and Individual Exchange plans.

Policy Summary

PayerUnitedHealthcare

PolicySame Day Medical Visits and Trauma Activation Reimbursement (UB04)

Policy CodePolicy 2025R6011A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionAppend modifier 25 to a status indicator V E/M when the E/M is separately identifiable from a same-day procedure with status indicator S or T.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1max units of G0390 per date

25modifier for separate E/M

Vstatus indicator for visit

Reimbursement Criteria

Reimbursement criteria

Criteria for separate reimbursement of E/M services and trauma activation:

Policy Summary

PayerUnitedHealthcare

PolicySame Day Medical Visits and Trauma Activation Reimbursement (UB04)

Policy CodePolicy 2025R6011A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionAppend modifier 25 to a status indicator V E/M when the E/M is separately identifiable from a same-day procedure with status indicator S or T.

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.

ALL of the following

Separate E/M reimbursement: A status indicator V evaluation and management (E/M) code may be submitted on the same date of service as a procedure with status indicator S or T only when the E/M is separately identifiable; modifier 25 must be appended to the E/M to indicate the service was separate and distinct.
Trauma activation reimbursement
- Prehospital notification occurred based on triage information from prehospital caregivers meeting local, state, or American College of Surgeons field triage criteria, or the patient was delivered by inter-hospital transfer and given the appropriate team response.
- G0390 is submitted with revenue code 68X (068X) on the same date of service as critical care service 99291.
- The facility is a trauma center/hospital licensed or designated by the state or local government authority authorized to do so, or verified by the American College of Surgeons (i.e., eligible to use revenue code 68X).
- Only one unit of G0390 is reimbursable per date of service (trauma activation is considered a one-time occurrence associated with critical care).

ALL of the following

When multiple medical visits occur on the same day, Condition Code G0 (Distinct Medical Visit) should be reported only if the visits occurred with the same revenue center and the visits were distinct and independent (for example, two separate ED visits in one day).
Trauma activation G0390 will not be considered for separate reimbursement if it is not performed on the same date of service as critical care service 99291.

Referenced Codes and Limits

Selected codes referencedmixed

G0390	Trauma activation
99291	Critical care, first 30-74 minutes
Condition Code G0	Distinct Medical Visit

Status V Medical Visit Codes (examples from policy)CPT

92002	mapped to 92004/92012/92014/95250 per position
98975	mapped to 99453/99460/99463/99495 per position
99496	mapped to G0175/G0245/G0246/G0248 per position
G0249	mapped to G0402 (other positions blank)

Trauma activation units per date

Maximum reimbursable units per dateOne unit of G0390 reimbursable per date of service

Associated critical care codeG0390 may be submitted on same date as 99291 (critical care)

Revenue code requirementG0390 must be submitted under revenue code 68X (068X)

Trauma center limitationRevenue code 68X may only be used by trauma centers licensed/designated by state/local authority or verified by the American College of Surgeons

Billing and Submission Actions

Billing Rule

Append modifier 25 for separately identifiable same-day E/M

Append modifier 25 to a status indicator V E/M when the E/M service is separately identifiable from a same-day procedure with status indicator S or T.

Append modifier 25 to the E/M code to indicate the E/M service performed was separate and distinct from the same-day procedure.

Documentation Required

Bill G0390 with revenue code 68X on same date as 99291; single unit only

Submit trauma activation code G0390 with revenue code 68X (068X) on the same date as critical care code 99291; only trauma centers licensed/designated by state/local authority or verified by the American College of Surgeons may use revenue code 68X, and only one unit of G0390 is reimbursable per date of service.

Prehospital notification based on field triage criteria or inter-hospital transfer with an appropriate team response is required to bill trauma activation.
Trauma activation will be considered for reimbursement only when revenue code 068X, HCPCS code G0390, and critical care code 99291 are all reported on the same date of service.
Maximum reimbursable units of G0390 is one per date of service.

Key Billing Definitions

Status Indicator V

DefinitionStatus Indicator V = Clinic or Emergency Department Visit

Use caseApplied to E/M services that represent clinic or ED visits for UB04 reporting

Relationship to modifiersWhen an E/M with Status Indicator V is separately identifiable from a same-day procedure, append modifier 25 (per policy guidance)

Revenue Code 68X

DefinitionRevenue Code 68X (068X) = Trauma Response

Billing pairingUsed to bill trauma activation code G0390 on the same date as critical care code 99291

Eligibility68X may only be used by trauma centers as licensed/designated by state/local authority or verified by the American College of Surgeons

Condition Code G0

DefinitionCondition Code G0 = Distinct Medical Visit

ContextUsed to indicate distinct medical visits when reported on UB04 claims

Related guidancePolicy Q&A clarifies G0 is not reported when visits are under different revenue codes (see policy details)