CurrentUnitedHealthcarePolicy N/A

Status M and Q code reimbursement and modifier denials

This policy governs reimbursement treatment of CPT/CMS codes designated as status M or Q and specifies modifiers that will cause denial when reported by physicians or other qualified healthcare professionals for UnitedHealthcare Community Plan Medicaid products.

Policy Summary

PayerUnitedHealthcare

PolicyStatus M and Q code reimbursement and modifier denials

Policy CodePolicy N/A

Change TypeOperational revisions (code list and state exceptions)

Effective Date

Next Review Date

Key ActionDo not bill Status M or Q codes as separately payable; such codes will be denied when reported on CMS-1500.

SourceLink

POLICY UPDATE CHANGES

Attachment Section: Status M and Q Codes list updated.

Modifier SL removed from the Modifier Section.

State exceptions updated (e.g., Missouri, New York) over multiple revisions.

2status code categories denied (M and Q)

3+modifiers listed that will cause denial

Multiplestate exceptions enumerated

Coverage and Reimbursement Criteria

Policy Summary

PayerUnitedHealthcare

PolicyStatus M and Q code reimbursement and modifier denials

Policy CodePolicy N/A

Change TypeOperational revisions (code list and state exceptions)

Effective Date

Next Review Date

Key ActionDo not bill Status M or Q codes as separately payable; such codes will be denied when reported on CMS-1500.

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.

Claims submitted on CMS-1500 (or electronic equivalent) must comply with coding and modifier guidance below; otherwise payment will be denied.

Deny payment for codes designated by the CMS NPFS Relative Value File with status M or status Q when reported on a CMS-1500 form; these codes are for reporting purposes only and are not separately payable.

Refer to Attachment for complete list of Status M and Status Q codes.

ALL of the following

Modifiers that will cause denial when appended to physician/qualified provider claims: 27, 73, 74, PO
Modifiers representing services funded by a county, state or federal agency (examples shown in policy) will cause denial when appended to physician/qualified provider claims (exceptions for ambulance transport modifier SE).

State exceptions: Allowances or exceptions exist for specific states as documented in the State Exceptions section; examples include Arizona, Colorado, Indiana, Kentucky, Missouri, New Jersey, New York, Ohio, Tennessee, and Texas.

See State Exceptions section for state-specific allowed codes and modifier exceptions (e.g., Arizona excludes modifiers 27/73/74 from denial; Ohio allows M and Q codes per MMP reporting).

Status Codes and Billing Forms

Status M and Q CodesmixedNot Covered

Status M	Measurement codes used for reporting purposes only (not separately payable).
Status Q	Therapy functional information codes used for required reporting purposes only (not separately payable).

Billing form

Applicable billing formPolicy applies to services reported on CMS-1500 (or electronic equivalent)

ScopeDenial applies when codes with CMS NPFS status M or Q are reported on CMS-1500 by physicians or other qualified health care professionals

Reference for complete code listSee Attachment section for complete list of status M and Q codes

Provider Billing and Denial Guidance

Denial Risk

Denial of Status M and Q Codes

Per CMS guidance and the NPFS Relative Value File, codes designated with status indicator M (Measurement codes) or Q (Therapy functional information codes) are for reporting purposes only. Do not bill these status M or Q codes as separately payable on the CMS-1500; UnitedHealthcare Community Plan will deny claims that report status M or Q codes on a CMS-1500 form.

Affected codes: all CPT/HCPCS codes with CMS NPFS Relative Value File status indicator = M or Q
Action: Do not report these codes as separately payable on CMS-1500; they will be denied

Denial Risk

Modifier-based Denials

Do not append the listed modifiers to physician or other qualified health care professional claims when those modifiers indicate an ASC/outpatient hospital setting or represent services funded by another governmental entity. UnitedHealthcare Community Plan will deny codes appended with these modifiers when reported by physicians or other qualified health care professionals.

ASC/outpatient modifiers that will cause denial when reported by physicians or other qualified health care professionals: 73, 74, PO (and similar ASC/outpatient-only modifiers)
Modifiers signifying services funded by a county, state or federal agency that will be denied when appended to physician or other qualified health care professional claims: HW, HV, QJ, HZ, H9, HX, TR, HU, HY (and other funded-service modifiers)
Exception: Ambulance transport providers may use modifier SE to report origin/destination as appropriate

Definitions: Status M and Q

Measurement codes (Status M)

DefinitionStatus M: Measurement codes used for reporting purposes only (not separately payable).

PayabilityCodes designated Status M by CMS NPFS are not separately payable and will be denied when reported on CMS-1500.

Purpose of designationAssigned to indicate codes are for reporting only per NPFS Relative Value File.

Therapy functional information codes (Status Q)

DefinitionStatus Q: Therapy functional information codes used for required reporting purposes only (not separately payable).

PayabilityCodes designated Status Q by CMS NPFS are not separately payable and will be denied when reported on CMS-1500.

Purpose of designationAssigned to indicate therapy functional reporting requirements per NPFS Relative Value File.