CurrentBlue Cross Blue Shield - NevadaPolicy C-23001

Bundled Services and Supplies - Facility

Defines facility-level bundled services and supplies that are ineligible for separate reimbursement and lists related CPT/HCPCS codes and state-specific exemptions; applies to facility providers billing Blue Cross Blue Shield - Nevada and other listed markets.

Policy Summary

PayerBlue Cross Blue Shield - Nevada

PolicyBundled Services and Supplies - Facility

Policy CodePolicy C-23001

Change TypeAdded bundled categoriesupdated state exemptions and related coding

Effective Date11/01/2024

Next Review Date

Key ActionEnsure services meet authorization and medical necessity guidelines and submit claims with proper, supported coding to avoid recovery, rejection, or denial.

SourceLink

POLICY UPDATE CHANGES

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

Added that chemotherapy administration and infusion administration are not eligible for separate reimbursement on the same date as a room or facility fee.

Added Colorado and Nevada exemptions.

Added code G2211 to Related Coding.

~6categories listed as bundled/not separately reimbursable

2024-11-01effective date

C-23001policy identifier

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.

Facility Bundled Services — Coverage Criteria

Facility bundled services - general rule

Facility providers will not be reimbursed separately for services and supplies that are considered integral to the primary service or included in the facility fee, unless provider, state, federal contract, or other requirements indicate otherwise.

Categories considered integral (including, but not limited to)

Facility personnel services
DME: set-up, delivery, and accessories
Feeding kits and supplies
Nursing services
Flushes and diluents
Pharmacy services
Routine supplies and equipment
Pulse oximetry

Same-date with room or facility fee

Infusion drug administration is not eligible for separate reimbursement 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.
Chemotherapy administration is not eligible for separate reimbursement 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.

State-specific exceptions (examples: Nevada, Maine, Kentucky, Wisconsin, Colorado)

State exemptions and allowances — specific state rules may permit separate reimbursement for certain items or HCPCS ranges; where applicable, follow the state-specific allowance below.

State-specific exemptions or allowances override the default facility bundling rule only to the extent required by the state or contractual obligations.

Examples by state

Nevada: Blue Cross and Blue Shield allows separate reimbursement for HCPCS C1887, C9359, and C9362.
Wisconsin: Allows separate reimbursement for routine supplies and equipment when submitted with HCPCS codes beginning with 'C'; allows separate reimbursement for feeding kits and supplies when submitted with HCPCS codes beginning with 'B'; allows separate reimbursement for chemotherapy administration and infusion administration.
Kentucky: Allows separate reimbursement for routine supplies and equipment when submitted with HCPCS codes beginning with 'C'. Will deny chemotherapy administration when submitted with a treatment room on the same date of service.

Related Coding — Bundled and Allowed Codes

Always bundled / not eligible for separate reimbursement (examples)mixedNot 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); severe acute respiratory syndrome (SARS-CoV-2). Not eligible for reimbursement.
97010	Application of a modality; hot or cold packs. Not eligible for reimbursement.
99070	Supplies and materials provided by physician over and above those usually included. Not eligible for reimbursement.
G2211	Visit complexity inherent to E/M. Not eligible for reimbursement.

State-specific allowed HCPCS (Nevada)HCPCSCovered

C1887	HCPCS allowed separately in Nevada per policy note
C9359	HCPCS allowed separately in Nevada per policy note
C9362	HCPCS allowed separately in Nevada per policy note

Authorization, Documentation, and Billing Compliance

Prior Authorization

Authorization and Medical Necessity

Prior Authorization Required: Certain services are subject to prior authorization and must meet medical necessity criteria before reimbursement will be approved. Verify authorization requirements with Blue Cross Blue Shield - Nevada and obtain prior authorization when indicated to avoid claim denials or delays.

Prior authorization may be required based on the member’s plan, service type, or diagnosis.
Authorization determinations affect whether a service is eligible for reimbursement — absence of authorization can lead to denial or recoupment.
Confirm authorization prior to the date of service when possible; appeal processes are available for adverse determinations.

Billing Rule

Billing Compliance Actions

Definitions

Bundled Services

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

Policy Revision History

06/12/2024review_approved

Review approved; policy changes documented including addition of Colorado and Nevada exemptions and categories not allowed for separate reimbursement when billed by a facility provider (DME set-up/delivery/accessories, facility personnel services, feeding kits/supplies, flushes/diluents, nursing services, pharmacy services, pulse oximetry, routine supplies/equipment) and that chemotherapy and infusion administration are not eligible separately on same date as a room/facility fee; Related Coding updated (added G2211).

08/28/2024administrative_review

Administrative review noted in history prior to effective date; confirms prior review actions (see 06/12/2024).