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UnitedHealthcareMedicare Advantage · Billing Codes · Medical Policy · Orthopedics, Pulmonology, Sleep Medicine +7 moreMedium impact

Durable Medical Equipment (DME), Prosthetics, Orthotics (Non-Foot Orthotics), Nutritional Therapy, and Medical Supplies Grid

Effective date
Dec 1, 2026
Identified
Nov 7, 2026

Summary

UnitedHealthcare's Medicare Advantage DME, prosthetics, orthotics and supplies grid is revised effective 2026-12-01: several items now defer to other coverage policies (foot cradles, insulin pumps, bead beds/egg crates, air-fluidized beds), a face-to-face encounter requirement is added for manual wheelchairs, oxygen, and ventilators, pediatric cribs language is removed, and several HCPCS codes are added or removed for artificial upper limbs, CPAP devices, lifts, lymphedema items and LLPS splints. The practice's billing team should update charge entry and claim edits for the changed code lists and confirm documentation for face-to-face encounters before dispensing these items to Medicare Advantage members.

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What to do

Action · 5 steps
01Already effective 2026-12-01: Billing team should update charge entry and claim edits for Medicare Advantage claims so that codes removed from the grid (including E0618, L6026, L6621, L6696, L6697, L6884, L7008, L7009, E0639, E0640, E1830) are no longer selected for these members, and newly listed codes (E0601, A6548) are routed correctly.
02Before scheduling or dispensing wheelchairs (E1161, E1232-E1238), oxygen, or ventilators (E0465-E0468) to Medicare Advantage members on or after 2026-12-01, the practice should have providers document a face-to-face encounter in the chart, and front desk staff should be told to verify this.
03For foot cradles, insulin pumps, bead beds, egg crates, and air-fluidized beds, the billing team should check the referenced coverage policies (Hospital Beds and Accessories, Pumps, Alternating Pressure Pads and Air-Fluidized Bed) and update encounter forms accordingly.
04Claims for pediatric cribs (E0300) should follow the payer's revised language, which no longer includes that section.
05Watch for the payer's next bulletin for further updates.

Codes mentioned

E0601E0618E0300E0194E0277E0373L6026L6621L6696L6697L6884L7008L7009L6611L6629L6632L6677L6680L6682L6686L6687L6688L6694L6695L6698L6715L6880L6881L6882L6883L6925L6935L6945L6955L6975L7007L7045L7180L7181L7190L7191L7259L7364L7366L7367L7368L7400L7401L7403L7404L8465A6548E0635E0636E1035E1036E0639E0640E1161E1232E1233E1234E1235E1236E1237E1238E1800E1810E1812E1815E1830E0465E0466E0467E0468A6530A6533A6534A6535A6536A6537A6538A6539A6540A6541A6544A6549

Original notice

Durable Medical Equipment (DME), Prosthetics, Orthotics (Non-Foot Orthotics), Nutritional Therapy, and Medical Supplies Grid
uhcprovider.com · Always check the source before changing claims.
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Related policy hubs

UnitedHealthcare policiesOrthopedicsPulmonologySleep MedicinePhysical TherapyWound CareOncologyEndocrinologyPlastic SurgeryPediatricsGeriatricsCode E0601Code E0618Code E0300Code E0194Code E0277Code E0373Code L6026Code L6621Code L6696Code L6697Code L6884Code L7008Code L7009Code L6611Code L6629Code L6632Code L6677Code L6680Code L6682Code L6686Code L6687Code L6688Code L6694Code L6695Code L6698Code L6715Code L6880Code L6881Code L6882Code L6883Code L6925Code L6935Code L6945Code L6955Code L6975Code L7007Code L7045Code L7180Code L7181Code L7190Code L7191Code L7259Code L7364Code L7366Code L7367Code L7368Code L7400Code L7401Code L7403Code L7404Code L8465Code A6548Code E0635Code E0636Code E1035Code E1036Code E0639Code E0640Code E1161Code E1232Code E1233Code E1234Code E1235Code E1236Code E1237Code E1238Code E1800Code E1810Code E1812Code E1815Code E1830Code E0465Code E0466Code E0467Code E0468Code A6530Code A6533Code A6534Code A6535Code A6536Code A6537Code A6538Code A6539Code A6540Code A6541Code A6544Code A6549

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