If you’re an anesthesiology practice dealing with UnitedHealthcare (UHC) claims, you’ve likely seen CPT 99291—the critical care code—come back denied. It’s frustrating when you’re providing life-saving care in the OR or ICU, only to have reimbursements stalled. These denials often show up as CO-45 (contractual adjustment) or CO-97 (service not separately payable), but the root cause? Documentation gaps, time mismatches, or policy misalignments. In this post, we’ll walk through why UHC flags 99291, how to fix it fast, and steps to prevent it—especially for mid-sized anesthesiology groups searching “UnitedHealthcare 99291 denial fix” or “anesthesia critical care billing UHC.”

What Triggers UHC 99291 Denials in Anesthesiology?

CPT 99291 covers the first 30–74 minutes of critical care time on a given date—hands-on, high-acuity management of unstable patients. UHC follows CMS guidelines but adds its own layer of scrutiny. Common denial triggers include:

• Time not documented clearly: You need to log exact start/stop times exclusive of procedures (like intubation or line placement, which are bundled).
• Overlap with anesthesia services: If 99291 is billed on the same day as anesthesia (00100–01999), UHC may deny it unless you prove the critical care was separate and medically necessary.
• Missing critical illness proof: Notes must show life-threatening conditions (e.g., septic shock, acute respiratory failure) with organ system involvement.
• Global period conflicts: Critical care during a surgical global period often gets rejected unless carved out.

Anesthesiology teams report 15–25% of 99291 claims denied on first pass with UHC—costing thousands per case if not appealed.

Step-by-Step: How to Resolve a UHC 99291 Denial

Don’t let a denial sit—appeal within 180 days for the best shot at recovery. Here’s your playbook:

1. Pull the EOB and Claim Details Check the remittance advice for the exact reason code (CO-45, CO-97, etc.). Note the date of service and UHC’s appeal address or portal link.
2. Audit Your Documentation Confirm:
   
   • Total critical care time (74 minutes minimum for full unit)
   • Time excluded from procedures (use a time log)
   • Diagnosis supporting critical status (e.g., J96.00, I46.9)
   • Physician’s personal involvement (no double-dipping with residents)

File the Appeal—Clean and Fast Use UHC’s Optum Provider Portal or fax. Sample appeal language:

“Appeal for CPT 99291 denial, DOS [date]. Critical care time: 82 minutes (1:15 PM – 2:37 PM), exclusive of anesthesia procedure (01520). Patient in acute respiratory failure (J96.01). Attached: Timed progress note, anesthesia record, and critical care flowsheet.”

3. Expect a response in 30–45 days.
   
   
4. Track and Follow Up Log appeals in your system. Call UHC Provider Services (877-842-3210) if no update after 45 days.

Many practices recover 70%+ of denied 99291 dollars with strong appeals—especially when time and necessity are crystal clear.

Prevent UHC 99291 Denials Before They Happen

Fixing denials is reactive—smart anesthesiology groups go proactive:

• Use time-stamped templates: Build EHR macros that auto-log critical care start/stop and exclude procedure time.
• Train on UHC policy: Review UHC’s Critical Care Policy quarterly—especially updates on bundling and global periods.
• Pre-bill scrub: Run 99291 claims through AI coding tools that flag time gaps or diagnosis mismatches before submission.
• Separate the services: When possible, have a different provider (e.g., intensivist) manage critical care post-anesthesia.

Groups using automated coding and eligibility checks see 99291 first-pass acceptance climb above 90%.

Ready to Stop UHC 99291 Denials in Their Tracks?

You shouldn’t have to fight for payment on critical care you’ve already delivered. With tight documentation, fast appeals, and smart automation, anesthesiology practices can cut 99291 denials and protect revenue.

Athelas RCM integrates directly with your EHR to flag 99291 risks in real time, auto-generate appeal packets, and boost clean claim rates—all without changing your workflow.

Book a demo and see how we help anesthesiology teams get paid faster for critical care.