Bundled Services and Supplies - Facility
Customize your policy alerts
Sign up for Blue Cross Blue Shield - Maine Policy C-23001 alerts
Get alerted when Policy C-23001 changes without checking for updates manually.
Monitor payer policy activity
Defines services and supplies that are ineligible for separate reimbursement when billed by inpatient and outpatient facility providers, and describes categories and specific codes considered always bundled. Affects facility providers billing Blue Cross Blue Shield - Maine members.
Added categories not allowed for separate reimbursement when billed by a facility provider including blood products; splitting, pooling, and thawing; radiation guidance; and travel related vaccinations and administration services.
Added categories not allowed for separate reimbursement on the same date of service with a room or facility fee including blood product administration, insertion of bladder catheters, and routine ECG (professional and technical component and supplies).
Added multiple CPT/HCPCS codes to the Related Coding section (examples: 76014-76019, 76979, 76983, 77293, 77387, 96521-96523, 99190-99192, C1734, C1762, C1763, L8699).
Bundling and Coverage Criteria
Bundling criteria
Services and supplies considered integral to the primary service or included in the facility fee will not be reimbursed separately when billed by a facility provider, unless otherwise mandated.
Categories generally bundled (including, but not limited to)
- Blood products; splitting, pooling, and thawing.
- Durable medical equipment (DME), including set-up, delivery, and accessories.
- Facility personnel services.
- Feeding kits and supplies.
- Flushes and diluents.
- Nursing services.
- Pharmacy services.
- Pulse oximetry.
- Radiation guidance (ultrasonic, fluoroscopic, CT, and MRI).
- Routine supplies and equipment.
- Travel-related vaccinations and administration services.
Services not separately reimbursable when billed on the same date as a room or facility fee or a procedure (other than the administration service)
- Blood product administration.
- Chemotherapy administration.
- Infusion drug administration.
- Insertion of bladder catheters.
- Routine ECG — professional and technical components and supplies.
This policy is subject to federal/state/contractual mandates and effective dates in Policy History; see Policy History (07/01/2026) for recent additions to the bundled categories and same-date restrictions.
Codes and Same-Date Rules
| 76983 | Ultrasound, elastography; each additional target lesion - Not eligible for reimbursement |
| 77293 | Respiratory motion management simulation - Not eligible for reimbursement |
| 77387 | Guidance for localization of target volume for delivery of radiation treatment - Not eligible for reimbursement |
| 96521 | Refilling and maintenance of portable pump - Not eligible for reimbursement |
| 96522 | Refilling and maintenance of implantable pump or reservoir - Not eligible for reimbursement |
| 96523 | Irrigation of implanted venous access device - Not eligible for reimbursement |
| 99070 | Supplies and materials provided over and above those usually included - Not eligible for reimbursement |
| 99190-99192 | Assembly and operation of pump with oxygenator or heat exchanger - Not eligible for reimbursement |
| C1734 | Orthopedic/device/drug matrix - Not eligible for reimbursement |
| L8699 | Prosthetic implant, not otherwise specified - Not eligible for reimbursement |
Billing, Authorization, and Documentation Guidance
Do not bill bundled services separately; confirm authorization and medical necessity
Do not bill separately for services and supplies that the policy identifies as bundled when those items are provided by an inpatient or outpatient facility; these items are considered integral to the primary service or included in the facility fee and will not be reimbursed separately unless provider, state, federal contract and/or requirements indicate otherwise. Also ensure that services meet authorization and medical necessity guidelines and are supported in the medical record to avoid denials or recoupment.
- Examples of categories generally included in the facility fee: blood products (including splitting, pooling, thawing), DME (including set‑up/delivery/accessories), facility personnel services, feeding kits/supplies, flushes/diluents, nursing, pharmacy, pulse oximetry, radiation guidance (ultrasonic, fluoroscopic, CT, MRI), routine supplies/equipment, and travel‑related vaccinations and administration services (see Related Coding for specific always‑bundled CPT/HCPCS codes).
- Do not expect modifiers to override denials for services listed as always bundled in the Related Coding section.
- Services billed on the same date as a room or facility fee (or a procedure other than the administration service) that are not separately reimbursable include blood product administration, chemotherapy administration, infusion drug administration, insertion of bladder catheters, and routine ECG (professional and technical components and supplies).
Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.