Bundled Services and Supplies - Facility
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Defines facility-level services and supplies that are considered bundled (not separately reimbursable) when billed by inpatient and outpatient facility providers; includes state-specific exemptions. Affects facility providers submitting claims to the payer.
No material clinical or coverage changes in this revision.
Coverage criteria and policy scope
Bundled services policy and state exemptions
Facility-billed services and supplies that are integral to a primary service or included in the facility fee are not separately reimbursable. Certain categories and specific CPT/HCPCS codes are always bundled; exceptions exist by state.
Categories generally bundled
- Blood products: splitting, pooling, and thawing
- DME, including set-up, delivery, and accessories
- Facility personnel services
- Feeding kits and supplies
- Flushes and diluents
- Nursing services
- Pharmacy services
- Pulse oximetry
- Radiology guidance: ultrasonic, fluoroscopic, CT, and MRI
- Routine supplies and equipment
- Travel related vaccinations and administration services
Categories not separately reimbursable on same date of service as room/facility fee
- Blood Product administration
- Chemotherapy administration
- Infusion Drug administration
- Insertion of bladder catheters
- Routine ECG; professional and technical component and supplies
State-specific exemptions (examples)
- Indiana: allows separate reimbursement for Routine ECG (professional and technical component and supplies) and for codes 96521-96523, 99190-99192.
- Kentucky: allows separate reimbursement for Routine supplies and equipment when submitted with HCPCS codes beginning with C; will only deny chemotherapy administration when submitted with a treatment room on the same date of service; blood product administration is not allowed for separate reimbursement when billed with Rev Code 076X on the same claim; allows Routine ECG and radiology guidance (per exemption updates).
- Wisconsin: allows separate reimbursement for codes 76979, 76983, 77293, 77387, 96521-96523, 99190-99192; allows Routine supplies and equipment when submitted with HCPCS codes beginning with C; allows Feeding kits and supplies when submitted with HCPC codes beginning with B; allows Chemotherapy administration and Infusion administration; allows Routine ECG (professional and technical component and supplies).
Operational notes
- Services must be billed with appropriate CPT, HCPCS and/or revenue codes and supported in the medical record; failure to follow coding/billing guidelines may result in claim rejection, denial, or recoupment.
See Authorization and medical necessity guidance
- State, federal contract, and provider-specific requirements may override the bundled rules; exemptions listed are state-specific and control for members in those markets.
Coverage stance and historical rule changes
Policy history entries describe categories added or removed from separate reimbursement eligibility, code-level changes, and state/market exemptions.
Examples of categories added or clarified in history
- Added radiology guidance (ultrasonic, fluoroscopic, CT, and MRI) as not separately reimbursable when billed by a facility provider (01/14/2026 history).
- Added travel related vaccinations and administration services as not separately reimbursable (01/14/2026 history).
- Added insertion of bladder catheters as not separately reimbursable on the same date of service with a room or facility fee (01/14/2026 history).
- Added blood products (splitting, pooling, thawing) and Blood Product administration language (09/24/2025 history).
- Added DME set-up, delivery, accessories; facility personnel services; feeding kits and supplies; flushes and diluents; nursing services; pharmacy services; pulse oximetry; routine supplies and equipment (06/12/2024 history).
Coding changes noted in history
State/market exemptions and updates
- Added New Hampshire exemption effective 02/27/2026 (history entry).
- Added Indiana and Ohio exemptions (11/17/2025 history) and added Colorado and Nevada exemptions earlier (08/28/2024 history).
- Kentucky and Wisconsin exemptions have been updated multiple times to allow specific categories and codes (e.g., Routine ECG, radiology guidance, codes 96521-96523, 99190-99192).
Billing and governance notes
- Codes added or removed in history are reflected in the Related Coding section; see coding module for details.
- Policy is subject to federal and state laws and member benefit terms; payer may recoup payments to the effective date if delayed implementation occurs.
- Due to delayed implementation in some markets, certain categories were temporarily allowed for separate reimbursement when billed by a facility provider; see specific history entries for affected markets and effective dates.
Related coding and code lists
| 15851 | Removal of sutures or staples requiring anesthesia (eg, general anesthesia, moderate sedation) |
| 76014 | MR safety implant and/or foreign body assessment, medical physics examination, or implant electronics preparation and positioning |
| 76015 | |
| 76016 | |
| 76017 | |
| 76018 | |
| 76019 | |
| 76979 | Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); each additional lesion with separate injection |
| 76983 | Ultrasound, elastography; each additional target lesion |
| 77293 | Respiratory motion management simulation (List separately in addition to code for primary procedure) |
| 76979 | Added to Related Coding (01/14/2026 history) |
| 76983 | Added to Related Coding (01/14/2026 history) |
| 77293 | Added to Related Coding (01/14/2026 history) |
| 77387 | Added to Related Coding (01/14/2026 history) |
| 76014-76019 | Added to Related Coding (11/17/2025 history) |
| 96521-96523 | Added to Related Coding (11/17/2025 history) |
| 99190-99192 | Added to Related Coding (11/17/2025 history) |
| C1734 | Added to Related Coding (11/17/2025 history) |
| C1762 | Added to Related Coding (11/17/2025 history) |
| C1763 | Added to Related Coding (11/17/2025 history) |
Billing rules and provider requirements
Bundling rule (facility)
The health plan considers certain services and supplies to be ineligible for separate reimbursement when reported for inpatient and outpatient facilities, unless provider, state, federal contract and/or requirements indicate otherwise. 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. Examples include blood product handling (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, radiology guidance (ultrasonic, fluoroscopic, CT, MRI), routine supplies and equipment, and travel-related vaccinations and administration services. The health plan will not allow 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, for categories such as blood product administration, chemotherapy administration, infusion drug administration, insertion of bladder catheters, and routine ECG (professional and technical components and supplies).
- Blood products: splitting, pooling, and thawing
- DME, including set-up, delivery, and accessories
- Facility personnel services
- Feeding kits and supplies
- Flushes and diluents
- Nursing services
- Pharmacy services
- Pulse oximetry
- Radiology guidance: ultrasonic, fluoroscopic, CT, MRI
- Routine supplies and equipment
- Travel-related vaccinations and administration services
- Categories not separately reimbursed when billed same date as room/facility fee or other procedure: Blood product administration; Chemotherapy administration; Infusion drug administration; Insertion of bladder catheters; Routine ECG (professional & technical components and supplies)
Always-bundled codes and modifier policy
The Related Coding section lists CPT and HCPCS Level II codes that are considered always bundled and not eligible for separate reimbursement when reported as a stand-alone service or with another service. No modifiers will override the denial for the always-bundled services and supplies listed. Providers should not expect modifier usage to bypass bundling determinations; these codes are denied regardless of modifier.
State exemptions
State-level exemptions may allow separate reimbursement for certain HCPCS/CPT codes or categories in specific states. Refer to the Exemptions section for state-specific details. Examples include allowances in Colorado, Indiana, Kentucky, Nevada, New Hampshire, Ohio, and Wisconsin for certain codes or categories (e.g., routine ECG, select HCPCS codes beginning with B or C, codes 76979, 76983, 77293, 77387, 96521-96523, 99190-99192). Verify member state and applicable contract or mandate to determine whether an exemption applies.
- Exemptions vary by state; check the Exemptions section for state-specific allowed codes and conditions.
- Examples of frequently exempted items (state-dependent): Routine ECG components and supplies; select HCPCS codes beginning with B or C; imaging guidance codes 76979, 76983, 77293, 77387; pump maintenance codes 96521-96523; service codes 99190-99192.
Authorization and medical necessity note
Services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis, as well as the member's state of residence. Use proper billing and submission guidelines and ensure services billed with CPT/HCPCS/revenue codes are fully supported in the medical record. Failure to follow coding/billing guidelines or current reimbursement policies may result in claim rejection, denial, or recovery/recoupment of payment.
- Confirm prior authorization and medical necessity where required.
- Support all billed services with documentation in the medical record.
- Noncompliance may result in rejection, denial, or recoupment.
Key definitions
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