ModifiedBlue Cross Blue Shield - MainePolicy C-23001

Bundled Services and Supplies - Facility

This commercial reimbursement policy defines facility services and supplies considered bundled (not eligible for separate reimbursement) when billed by inpatient and outpatient facilities, and notes state-specific exceptions where applicable.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyBundled Services and Supplies - Facility

Policy CodePolicy C-23001

Change TypeMaterial updates to bundled categories, related coding additions and state exemption adjustments

Effective Date04/01/2026

Next Review DateN/A

Key ActionDo not bill separately for services or supplies that are integral to the primary service or included in the facility fee when submitted by a facility provider.

SourceLink

POLICY UPDATE CHANGES

Added categories not allowed for separate reimbursement for facility providers on the same date of service with a room or facility fee including Routine ECG professional/technical component and supplies.

Added codes 76014-76019, 96521-96523, 99190-99192, C1734, C1762, C1763, C1781, C1889, and L8699 to Related Coding section.

Added Blood products (splitting, pooling, thawing) and Blood Product administration language; updated certain state exemptions and removed Maine exemptions.

Services considered integral to the primary service or included in the facility fee will not be allowed for separate reimbursement when billed by a facility provider.

Added code G2211

Deleted codes 94760-94762, A4206-A4262, A4265-A9300, A9900-A9901, A9999

8+categories listed as examples of bundled services/supplies

multiplespecific codes marked not eligible

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.

Bundled Services Coverage Criteria

Bundled services coverage criteria

The plan will not allow separate reimbursement for specified categories and codes when billed by facility providers; certain state exemptions and historical changes apply.

Services integral to the primary service or included in the facility fee are not eligible for separate reimbursement when billed by a facility provider.

ALL of the following

Blood Product administration
Chemotherapy administration
Infusion Drug administration
Routine ECG; professional and technical component and supplies

Specific CPT/HCPCS codes listed in the Related Coding section are considered always bundled and not eligible for separate reimbursement when reported by a facility provider; modifiers will not override denial for these codes.

State-specific allowances/exceptions: Certain states have exemptions or allowances that permit separate reimbursement for some categories or codes; review state notes and Related Coding for details (examples noted include Kentucky, Nevada, Ohio, Wisconsin, Indiana, Colorado).

Policy changes and effective dates: the policy was revised with additions of categories and codes and with state exemption adjustments (see policy history for details and effective implementation dates).

Coverage notes and administrative limits

Coverage stance, administrative limits, and operational notes that govern application of the bundled services policy.

Policies apply to both participating and nonparticipating providers unless otherwise noted; services must meet member benefit coverage, authorization, and medical necessity requirements appropriate to the procedure, diagnosis, and member's state of residence.

Reimbursement policies serve as guidance for claims submission; services must be billed with appropriate CPT, HCPCS, and/or revenue codes and fully supported in the medical record; failure to comply may result in claim rejection, denial, or recoupment.

Payer policies may be superseded by provider, state, federal, or CMS mandates or contract requirements; when such mandates apply they take precedence over this policy.

Market and historical notes: Policy history documents market-specific exemptions and changes: Maine exemption was added then removed (removed effective 06/01/2024); Kentucky and Wisconsin exemptions were added/updated; Indiana and Ohio exemptions were added; codes and effective dates (e.g., G2211 effective 11/01/2024) are recorded in Related Coding updates.

Related Coding and Billing Rules

Always bundled / not eligiblemixedNot Covered

15851	Removal of sutures or staples requiring anesthesia — Not eligible for reimbursement
76014-76019	MR safety implant and/or foreign body assessment, medical physics examination, or implant electronics preparation and positioning by trained clinical staff, physician or other qualified health care professional — Not eligible for reimbursement
87913	Infectious agent genotype analysis by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), mutation identification in targeted region(s) — Not eligible for reimbursement
96521-96523	Refilling and maintenance of portable pump; Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic; Irrigation of implanted venous access device for drug delivery systems — 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
99190-99192	Assembly and operation of pump with oxygenator or heat exchanger — Not eligible for reimbursement

Additional bundled codesmixedNot Covered

C1734	Orthopedic/device/drug matrix for opposing bone-to-bone or soft tissue-to bone (implantable) — Not eligible for reimbursement
C1762	Connective tissue, human (includes fascia lata) — Not eligible for reimbursement
C1763	Connective tissue, nonhuman (includes synthetic) — Not eligible for reimbursement
C1781	Mesh (implantable) — Not eligible for reimbursement
C1889	Implantable/insertable device, not otherwise classified — Not eligible for reimbursement
L8699	Prosthetic implant, not otherwise specified — 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 of the infusion in the community setting using a portable pump provided by the office/clinic, includes follow up office/clinic visit at the conclusion of the infusion — Not eligible for reimbursement when submitted by a facility provider

Related Coding updatesCPT | HCPCS | mixed

G2211	Added to Related Coding section (Visit complexity inherent to evaluation and management) — Added (effective 11/01/2024)
94760-94762	Deleted codes
A4206-A4262	Deleted codes
A4265-A9300	Deleted codes
A9900-A9901	Deleted codes
A9999	Deleted code

Same date as facility fee or room charge — short rule and examples

RuleServices/supplies billed on the same date of service as a room or facility fee, or a procedure (other than an administration service), will not be separately reimbursed when billed by a facility provider.

Examples — categories affectedBlood Product administration; Chemotherapy administration; Infusion Drug administration; Routine ECG (professional and technical component) and supplies.

Scope noteApplies to inpatient and outpatient facility providers unless provider, state, federal contract and/or requirements indicate otherwise.

ImplicationServices integral to the primary service or included in the facility fee are considered bundled and not eligible for separate reimbursement when submitted by a facility provider.

Billing and Authorization Requirements for Providers

Billing Rule

Bundled services — do not bill separately

Do not bill separately for services or supplies that are integral to a primary service or included in the facility fee when submitted by a facility provider. The plan considers certain services and supplies ineligible for separate reimbursement when reported for inpatient and outpatient facilities. Examples include, but are not limited to: blood product splitting/pooling/thawing; DME including 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. The plan will also deny separate reimbursement for specified services when billed on the same date of service as a room or facility fee or a procedure other than the administration service by a facility provider (for example: blood product administration, chemotherapy administration, infusion drug administration, routine ECG professional/technical components and supplies).

Examples of services/supplies considered bundled and not separately reimbursable: blood product splitting/pooling/thawing; DME (set-up, delivery, accessories); facility personnel services; feeding kits/supplies; flushes/diluents; nursing services; pharmacy services; pulse oximetry; routine supplies/equipment.
Services not separately reimbursable on same date as room/facility fee or another procedure (when billed by a facility provider): blood product administration; chemotherapy administration; infusion drug administration; routine ECG (professional and technical components and supplies).

Definitions and Billing Expectations

Bundled Services — definition

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

InterpretationBundled services are treated as integral to the primary service or included in the facility fee and therefore not payable separately when billed by a facility provider.

Relation to codingSpecific CPT/HCPCS codes listed in the Related Coding section are designated as always bundled and not eligible for reimbursement when reported by a facility provider.

Reimbursement Policy — purpose and use

PurposeThese reimbursement policies serve as a guide to assist in accurate claims submissions and to outline the basis for reimbursement if the service is covered by a member's benefit plan.

Application