99401-99404 with UnitedHealthcare: what the policy says
By Javier Alvarez · Updated · 2 min read
1 row: UnitedHealthcare. Public policy, not the member's benefits.
UnitedHealthcare
Commercial and Individual Exchange · All states
| 97802 | Listed (on the preventive rows) [1] |
|---|---|
| 97803 | Listed (on the preventive rows) [1] |
| G0270 | Listed (on the preventive rows) [1] |
| G0271 | Listed (on the preventive rows) [1] |
| Diagnoses | Prediabetes row: R73.03, ages 35 to 70. Healthy diet row: one of the listed cardiovascular risk factor codes. Weight-loss row: Z68.30 to Z68.45, or E66.01, E66.09, E66.1, E66.2, E66.811 to E66.813, E66.89, E66.9, E88.82. Z71.3 is not on these lists. [1] |
| Other codes | 97804 and 99401 to 99404 on the preventive rows. S9470 is replaced by 97802 or 97803. [1][2] |
| Telehealth POS | POS 02 or 10, with live audio and video, for codes on UHC's Telehealth Eligible Services list. [3] |
| Telehealth modifier | Not required. UHC accepts 95, GT, GQ and G0 as informational. [3] |
| Visit limits | Not published: call the payer. |
| Referral and prior auth | Not published: call the payer. |
- UnitedHealthcare: Preventive Care Services, commercial and individual exchange medical policy (effective 10/01/2026), checked October 30, 2026
- UnitedHealthcare: Replacement Codes Policy, Professional, 2026R0128A (PDF), checked October 22, 2026
- UnitedHealthcare: Telehealth/Virtual Health Policy, Professional, 2026R0046A (PDF), checked October 22, 2026
What UnitedHealthcare's policy says about 99401-99404
99401-99404 is the CPT code for preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure), approximately 15, 30, 45 and 60 minutes. At UnitedHealthcare it is listed: named in the payer's public policy. Each line below is from UnitedHealthcare's own text:
- Where it is listed. The wellness examinations row lists 99401 to 99404 and the group codes 99411 and 99412. (UnitedHealthcare, checked October 30, 2026)
- Billed with. On the STI behavioral counseling and tobacco cessation rows there is no diagnosis requirement. (UnitedHealthcare, checked October 30, 2026)
- When it pays. On the weight loss, cardiovascular risk and child BMI rows, 99401 to 99404 need one of that row's diagnosis codes. (UnitedHealthcare, checked October 30, 2026)
- Diagnosis position. A listed diagnosis does not have to be the only diagnosis on the claim, and most preventive services do not need it in the primary position. (UnitedHealthcare, checked October 30, 2026)
99401-99404 at other payers
- 99401-99404 with BCBS of IL, TX, OK and NM (HCSC): limited.
- 99401-99404 with Blue Cross NC: listed.
- 99401-99404 with Blue Cross Blue Shield of Massachusetts: limited.
- 99401-99404 with Cigna: listed.
- 99401-99404 with Anthem Blue Cross and Blue Shield: listed.
The rest of UnitedHealthcare's MNT rules
The UnitedHealthcare row has its codes, telehealth rule, limits and referrals, each with its source. Other codes we checked at UnitedHealthcare: 97803, E66, Z68, R73.03 and G0447. What 99401-99404 means at any payer is on the 99401-99404 code page. Before the claim goes out, compare it with the row in the table above, then download the PDF of what you see.