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UHC Revision to the Nonphysician Health Care Professionals Billing Evaluation and Management Codes


UnitedHealthcare does not currently reimburse Evaluation and Management (E/M) CPT codes 99201-99499 when submitted by specific nonphysician health care professionals. According to the Centers for Medicare and Medicaid Services (CMS), E/M services are reimbursable to certain non physician practitioners, limited to nurse practitioners, clinical nurse specialists, certified nurse midwives, and physician assistants.

Effective in the second quarter of 2015, UnitedHealthcare will expand the scope of this policy to not reimburse E/M CPT 99201-99499 when reported by the following nonphysician health care professionals:

• Licensed practical nurse
• Licensed vocational nurse
• Home health/private duty nurse
• Visiting nurse
• Behavioral analyst
• Genetic counselor
• Alcohol and drug counselor
• Crisis diversion
• Employee assistance program (EAP) counselor
• Empowerment coach
• Marriage & family therapy/licensed marriage and family therapy
• Licensed professional counselor
• Substance abuse services, alcohol & drug
• Other mental health counselor
• Christian science practitioner
• Registered social worker
• Marriage and family social worker
• Pharmacist

These professionals should review the CPT and healthcare common procedure coding system (HCPCS) national code sets to select a more accurate code that describes the services they are providing.


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