CurrentAnthemPolicy C-08003

Bundled Services and Supplies - Professional, Commercial Reimbursement Policy

Defines professional services and supplies that are ineligible for separate reimbursement (always bundled, bundled when reported with specific other services, or bundled when reported with any other service) for Anthem commercial plans; applies to professional providers unless overridden by contracts or law.

Policy Summary

PayerAnthem

PolicyBundled Services and Supplies - Professional, Commercial Reimbursement Policy

Policy CodePolicy C-08003

Change TypeOperational updates to code lists and policy cross-references

Effective Date12/01/2025

Next Review DateN/A

Key ActionDo not bill listed services and supplies separately for professional providers unless contract or law requires otherwise; modifiers generally will not override denials.

SourceLink

POLICY UPDATE CHANGES

Updated code lists and added new codes (G9038, Q0521, 0902T-0905T, 0945T) and new categories (CMS MPFS RVU Status M Indicator codes, HCPCS H Codes).

Removed telehealth originating site facility fee (Q3014) when reported with an E&M code in place of service 11 and moved that edit to Virtual Visits policy (C-08002).

Added modifiers XE, XP, XS, and XU to cross-reference for Modifier 59 policy.

3policy sections

multiplecode list updates

12/01/2025effective

09/03/2025last approval

Bundling and Coverage Rules

Bundling criteria

Coverage stance and bundling rules are organized into three sections:

Section 1 - Always bundled: Codes listed in Section 1 are not eligible for separate reimbursement when reported by a professional provider, whether reported with another service or as a stand-alone. In most cases, services rendered without direct (face-to-face) patient contact are considered integral to the overall medical management service and are not eligible for separate reimbursement. Modifiers will not override denials for the always bundled services and/or supplies listed in Section 1.

Section 2 - Code pairs: Specific procedures, services and supplies listed in Section 2 are not eligible for separate reimbursement when reported with the specified other procedure, service, or supply. In most cases, modifiers will not override the denial when reported with a specified service or supply.

Section 3 - Bundled with any other service: Services listed in Section 3 may be reimbursable as stand-alone but are not eligible for separate reimbursement when performed with any other procedure, service, or supply. Modifiers 59, XE, XP, XS, XU will not override denials for these services when reported with any other procedure, service, or supply.

Policy Summary

PayerAnthem

PolicyBundled Services and Supplies - Professional, Commercial Reimbursement Policy

Policy CodePolicy C-08003

Change TypeOperational updates to code lists and policy cross-references

Effective Date12/01/2025

Next Review DateN/A

Key ActionDo not bill listed services and supplies separately for professional providers unless contract or law requires otherwise; modifiers generally will not override denials.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Codes and Modifier Guidance

Section 1 — Always bundled categories and example new codesCPT | HCPCSNot Covered

G9038, Q0521, 0902T-0905T, 0945T

Newly added codes to Section 1 always bundled list (added 09/03/2025).

Section 2 — Specific pairings updatedHCPCSNot Covered

Q3014

Telehealth originating site facility fee — removal from Section 2 pairing when reported with E/M in place of service 11 (moved to Virtual Visits policy).

Modifier override — Section 3

Modifier overrideModifiers 59, XE, XP, XS, XU will not override denials for Section 3 services when reported with any other procedure, service, or supply.

Scope of applicationApplies to services listed in Policy Section 3 that are reimbursable as stand-alone but bundled when reported with any other service.

Modifiers referencedIncludes modifier 59 plus SEPARATE modifiers XE, XP, XS, and XU as non‑overriding for Section 3 denials.

Billing and Documentation Guidance

Billing Rule

Billing and modifier guidance — modifiers and contractual overrides

Services and supplies listed are not eligible for separate reimbursement when reported by professional providers unless provider, state, or federal contracts and/or requirements indicate otherwise. Modifiers generally will not override denials for always bundled services and for specified pairings; XE, XP, XS, and XU modifiers are referenced for the Modifier 59 policy and modifiers 59/XE/XP/XS/XU will not override denials for Section 3 services when reported with any other procedure/service.

Provider, state, or federal contracts and requirements supersede this policy when applicable.
Modifiers will not override denials for Section 1 (always bundled) and typically will not override denials for Section 2 pairings.
Modifiers 59, XE, XP, XS, XU will not override denials for services listed in Section 3 when reported with any other procedure/service.

Key Definitions

Bundled / incident-to

Definition — Bundled / incident-toItems or services that are not eligible for separate reimbursement and considered incident to another service rendered on the same date of service.

Typical rationaleServices rendered without direct (face-to-face) patient contact are considered integral to overall medical management and not eligible for separate reimbursement.

ApplicabilityApplies to professional providers unless provider, state, or federal contracts or requirements indicate otherwise.

Policy section definitions

Section 1 — Always bundledServices and supplies listed in Section 1 are not eligible for separate reimbursement when reported by a professional provider, whether reported with another service or as a stand-alone; modifiers will not override denials for these items.

Section 2 — Specific pairingsProcedures, services and supplies listed in Section 2 are not eligible for separate reimbursement when reported with the specific other procedure, service, or supply identified; modifiers generally will not override these denials.

Section 3 — Bundled with any other serviceServices listed in Section 3 may be reimbursable as stand-alone but are not eligible for separate reimbursement when performed with any other procedure, service, or supply; modifiers 59, XE, XP, XS, XU will not override denials.