These factors may include, but are not limited to: legislative mandates, the physician or other provider contracts, and/or the member specific benefit plan documents**. Other factors affecting reimbursement may supplement, modify or, in some cases, supersede the Reimbursement Policies. Further, the Reimbursement Policies do not address all issues related to reimbursement for health care services provided to UnitedHealthcare members. Accordingly, UnitedHealthcare may use reasonable discretion in interpreting and applying the Reimbursement Policies to health care services provided in a particular case. Reimbursement Policies are intended to serve only as a general resource for the services described and are not intended to address every aspect of a reimbursement situation. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing Reimbursement Policies. The Reimbursement Policies apply to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms (CMS 1450). References to CPT® or other sources are for definitional purposes only and do not imply any right to reimbursement. The Reimbursement Policies use Current Procedural Terminology (CPT®*), Centers for Medicare and Medicaid Services (CMS), or other coding guidelines. The Reimbursement Policies are intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. You are responsible for submission of accurate claims. The UnitedHealthcare Medicare Advantage Reimbursement Policies ("Reimbursement Policies") are applicable to UnitedHealthcare Medicare Advantage Plans offered by UnitedHealthcare and its affiliates. Please read the terms and conditions below carefully.
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