CurrentBlue Cross Blue Shield - MainePolicy C-23001

Bundled Services and Supplies - Facility

Governs when certain services and supplies billed by inpatient and outpatient facility providers are ineligible for separate reimbursement and therefore considered bundled with a primary service or facility fee; applies to Blue Cross Blue Shield - Maine commercial facility claims unless otherwise required by provider, state, or federal contracts.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyBundled Services and Supplies - Facility

Policy CodePolicy C-23001

Change TypeAdded and removed related codingexpanded bundled categories

Effective DateApr 1, 2026

Next Review Date

Key ActionDo not expect separate reimbursement for services/supplies identified as bundled when billed by a facility provider; ensure services meet authorization and medical necessity guidelines and follow proper billing/submission guidelines to avoid denials or recoupment.

SourceLink

POLICY UPDATE CHANGES

Added categories that will not be allowed for separate reimbursement when billed by a facility provider, including DME (set-up, delivery, and accessories), facility personnel services, feeding kits and supplies, flushes and diluents, nursing services, pharmacy services, pulse oximetry, and routine supplies and equipment.

Added that chemotherapy administration and infusion drug administration are not allowed for separate reimbursement when billed on the same date of service as a room or facility fee by a facility provider.

Added code G2211 to the Related Coding list of codes considered not eligible for reimbursement.

Deleted codes 94760-94762, A4206-A4262, A4265-A9300, A9900-A9901, A9999 from the Related Coding list.

10+Related coding entries not eligible

8Newly listed categories

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyBundled Services and Supplies - Facility

Policy CodePolicy C-23001

Change TypeAdded and removed related codingexpanded bundled categories

Effective DateApr 1, 2026

Next Review Date

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.

Bundling and Coverage Criteria

Bundling Criteria

Services and supplies considered integral to a primary service or included in the facility fee will not be reimbursed separately when billed by a facility provider. The following criteria describe when items are considered bundled and therefore not eligible for separate reimbursement:

ALL of the following

Examples of categories considered bundled
- DME, including set-up, delivery, and accessories
- Facility personnel services
- Feeding kits and supplies
- Flushes and diluents
- Nursing services
- Pharmacy services
- Pulse oximetry
- Routine supplies and equipment
Same-date bundling rule
- Chemotherapy administration
- Infusion drug administration
Always-bundled codes
- Codes listed in the Related Coding section are considered always bundled and not eligible for reimbursement when reported as a stand-alone service or with another service; no modifier will override denials for these items.

Codes and Same-Date Bundling Rules

Always bundled / not eligible for separate reimbursementmixedNot Covered

15851	Removal of sutures or staples requiring anesthesia (ie, general anesthesia, moderate sedation) - Not eligible for reimbursement
87913	Infectious agent genotype analysis by nucleic acid (DNA or RNA); SARS-CoV-2 mutation identification in targeted region(s) - Not eligible for reimbursement
97010	Application of a modality to 1 or more areas; hot or cold packs - Not eligible for reimbursement
99070	Supplies and materials (except spectacles) provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered - Not eligible for reimbursement
99072	Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other nonfacility service(s) during a Public Health Emergency (due to respiratory-transmitted infectious disease) - Not eligible for reimbursement
G0498	Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies with continuation in the community using a portable pump provided by the office/clinic, includes follow up office/clinic visit - Not eligible for reimbursement
G2211	Visit complexity inherent to evaluation and management associated with medical care services (visit complexity inherent to E/M) - Not eligible for reimbursement
K1034	Provision of COVID-19 test, nonprescription self-administered and self-collected use, FDA approved/authorized/cleared, one test count - Not eligible for reimbursement
T1040	Medicaid certified community behavioral health clinic services, per diem - Not eligible for reimbursement

Same-date bundling rule — services not eligible for separate reimbursement when billed on same date as room/facility fee

RuleServices listed are not eligible for separate reimbursement when billed on the same date of service as a room or facility fee or another procedure (except administration services by a facility provider).

Applies toInpatient and outpatient facility providers unless provider, state, federal contract or requirements indicate otherwise.

ExceptionsAdministration services billed by a facility provider are not subject to the same-date bundling restriction for chemotherapy/infusion administration.

ImpactNo modifiers will override a denial for services/supplies listed as always bundled when billed on the same date as a room/facility fee.

Billing and Authorization Notes

Billing Rule

Billing and authorization: Do not expect separate reimbursement; follow authorization, coding, and documentation rules

Do not expect separate reimbursement for services or supplies identified as bundled when billed by a facility provider; ensure services meet authorization and medical necessity guidelines and follow proper billing and submission guidelines to avoid denials or recoupment.

Services integral to the primary service or included in the facility fee (e.g., DME set‑up/delivery/accessories, facility personnel services, feeding kits, flushes/diluents, nursing, pharmacy, pulse oximetry, routine supplies/equipment) are not eligible for separate reimbursement when billed by a facility provider.
Chemotherapy administration and infusion drug administration are not eligible for separate reimbursement when billed on the same date of service as a room or facility fee (administration services by a facility provider are an exception).
No modifier will override a denial for services/supplies listed as always bundled.
Use correct CPT/HCPCS/revenue codes and ensure claims are fully supported in the medical record; failure to follow billing/submission guidelines may result in claim rejection/denial or recovery/recoupment.

Key Definitions

Bundled Services — services considered part of another service and not eligible for separate reimbursement

DefinitionBundled Services — Services that are not eligible for separate reimbursement and considered to be part of another service.

Example categories (facility billing)DME (including set-up, delivery, and accessories); Facility personnel services; Feeding kits and supplies; Flushes and diluents; Nursing services; Pharmacy services; Pulse oximetry; Routine supplies and equipment.

Related coding noteThe Related Coding list identifies CPT/HCPCS codes considered always bundled and not eligible for reimbursement when reported as stand‑alone or with another service.