CurrentUnitedHealthcarePolicy 2025R9036A

Reimbursement for standby and hospital-mandated on-call services billed on CMS 1500

Governs UnitedHealthcare Medicare Advantage reimbursement for services billed on the CMS 1500 form related to physician standby and hospital-mandated on-call services; applies to network physicians and other qualified health care professionals under Medicare Advantage plans.

Policy Summary

PayerUnitedHealthcare

PolicyReimbursement for standby and hospital-mandated on-call services billed on CMS 1500

Policy CodePolicy 2025R9036A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionSubmit accurate CMS 1500 claims describing services provided and monitor CMS guidance for changes.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

99360standby services excluded

99026/99027hospital-mandated on-call excluded

CMS 1500claim form

Medicare Advantageplan applicability

Coverage Position

Standby and hospital-mandated on-call reimbursement criteria

UnitedHealthcare Medicare Advantage reimbursement position for standby and mandated on-call services billed on CMS 1500:

Services reported on the CMS 1500 form or electronic equivalent must follow CPT and CMS coding guidelines; providers must submit accurate claims describing services rendered.

Excluded services (NOT reimbursed)

CPT 99360 — Standby services: prolonged attendance without direct (face-to-face) patient contact; care or services may not be provided to other patients during this period. Payment for standby services is included in the facility Part A payment; UnitedHealthcare Medicare Advantage does not reimburse CPT 99360.
CPT 99026 — Hospital mandated on-call service: does not involve direct patient contact; not reimbursed by UnitedHealthcare Medicare Advantage.

Policy Summary

PayerUnitedHealthcare

PolicyReimbursement for standby and hospital-mandated on-call services billed on CMS 1500

Policy CodePolicy 2025R9036A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionSubmit accurate CMS 1500 claims describing services provided and monitor CMS guidance for changes.

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.

Code Coverage and Definitions

Excluded codesCPTNot Covered

99360	Standby services — not reimbursed by UnitedHealthcare Medicare Advantage per CMS guidance
99026	Hospital mandated on-call services — not reimbursed
99027	Hospital mandated on-call services — not reimbursed

When standby time results in a billed serviceCPTCovered

88331

Example of reportable service if standby physician directly renders a billable service (frozen section tissue examination)

Standby definition requirement - key facts

DefinitionStandby services (CPT 99360): physician or other qualified health care professional attendance requested by another individual involving prolonged attendance without direct (face-to-face) patient contact.

Care restrictionCare or services may not be provided to other patients during the standby period.

Non‑proctoringDo not report CPT 99360 for time spent proctoring another individual.

Procedure exceptionDo not use CPT 99360 if the standby period ends with the performance of a procedure subject to a surgical package by the individual who was on standby.

Payment policy (most actionable)UnitedHealthcare Medicare Advantage does not reimburse CPT 99360; payment for standby services is included in facility Part A payment.

Billing and Provider Responsibilities

Billing Rule

Provider billing responsibilities for CMS 1500 claims

Submit accurate CMS 1500 claims that report the code or codes that correctly describe the health care services provided; this policy applies to services billed on the CMS 1500 form or its electronic equivalent for UnitedHealthcare Medicare Advantage. Monitor CMS guidance and coding updates regularly, as UnitedHealthcare Medicare Advantage may modify this policy to comply with CMS and national coding guideline changes. Note: this reimbursement policy does not include notations regarding prior authorization requirements.

Report services on the CMS 1500 (or electronic equivalent) using the CPT/CMS codes that accurately describe the service.
Keep current with CMS policy and national coding guideline changes; UnitedHealthcare may publish a new version of this policy to reflect those changes.
This policy does not include prior authorization notations—check other resources or plan documents for prior auth requirements.

Key Terms

Standby services (CPT 99360)

Code and descriptorCPT 99360 — Standby services: physician or other qualified health care professional attendance requested by another individual involving prolonged attendance without direct face-to-face patient contact.

When not usedNot used to report proctoring or when standby ends with a procedure subject to a surgical package.

Reporting alternativeIf the standby physician directly renders a specific billable service (e.g., tissue examination of frozen section), report the appropriate CPT code (e.g., 88331).

Reimbursement stance (most actionable)UnitedHealthcare Medicare Advantage does not reimburse CPT 99360; payment included in facility Part A payment.

Mandated hospital on-call services (CPT 99026, 99027)

CodesCPT 99026 and CPT 99027 — hospital mandated on-call services.

Service descriptionServices requiring physician on-call availability that do not involve direct patient contact.

Reimbursement stance (most actionable)UnitedHealthcare Medicare Advantage does not reimburse CPT 99026 or CPT 99027 because they do not involve direct patient contact.

Claim form applicabilityThese services are addressed in this CMS 1500 reimbursement policy for Medicare Advantage plans.