CurrentBlue KCPolicy POL-PP-111

Facility Routine Supplies and Services

Defines facility-level non-reimbursable routine supplies, services, equipment and related billing guidance for inpatient and outpatient settings for Blue KC lines of business and affected provider types.

Policy Summary

PayerBlue KC

PolicyFacility Routine Supplies and Services

Policy CodePolicy POL-PP-111

Change TypeClarified; Revised; Removed items

Effective DateSep 1, 2018

Next Review DateSep 1, 2026

Key ActionWhen billing an unlisted HCPCS code, submit medical records for review; prefer HCPCS Level II codes over 99070.

SourceLink

POLICY UPDATE CHANGES

Clarification added on ventilator management being included in facility charges as it is considered an integral part of the overall care provided to a patient requiring mechanical ventilation.

Ventilator management (CPT 94002, 94003) will be allowed once per day when submitted by a physician, advanced practice provider, or respiratory therapist.

Removed blood drawn from capillary, arterial, or vascular access devices from being considered part of lab fee.

Removed 'low osmolar' from Contrast material for inpatient or outpatient radiology procedures.

POL-PP-111Policy identifier

Commercial, Medicare Advantage, FEP, ACALines of business impacted

2026-09-01Next review date

Once per day

Facility items and services included in facility charges

Non-separately reimbursable facility items and services

Items and services included in facility charges and not eligible for separate reimbursement include (but are not limited to):

Routine services are incorporated into room and board, facility, or ancillary service charges and are not separately reimbursable; routine aspects of ancillary services will not be reimbursed separately.

Examples — medical equipment / supplies

Items associated with revenue codes 260-269, 270, 279, 410, and 412 (e.g., IV therapy, infusion pumps, perfusion equipment, anesthesia machines, CPAP, humidifiers, fetal monitors).
Reusable items and supplies provided to all patients (floor stock) such as beds, commodes, scales, monitors, tubing, and common reusable equipment or items.

Examples — medical/surgical supplies

Items associated with revenue codes 250, 270-279 (e.g., alcohol swabs/pads, bandages/dressings, batteries, IV solutions, saline and heparin/IV flushes, specimen collection items).
Nursing care and services performed by bedside nurses, respiratory therapists, certified nursing assistants, perfusionists, or other technicians as part of daily responsibilities (included in room and board).

Examples — nursing and supportive services

Administration of blood or medications, assisting physician with procedures, accessing indwelling IV catheters, monitoring (vital signs, cardiac monitoring), personal hygiene, point-of-care testing, respiratory treatments, tracheostomy care, IV/PICC insertions and related maintenance — all included in room/facility reimbursement.

Examples — surgical rooms and recovery services

Recovery room services (time or flat fee) including equipment, monitoring, nursing care, injection fees, intermittent compression devices, defibrillator, oxygen, EKG monitoring, pulse oximeter and similar items — not separately reimbursed.
Operating room equipment and supplies integral to procedures (anesthesia equipment, monitors, gases, laparoscopes, bronchoscopes, endoscopes, fluoroscopy accessories, grounding pads, hemochron supplies) are included in facility charges.

Ventilator management

Ventilator management CPT 94002 (initial day) and 94003 (subsequent day) is allowed once per day when submitted by a physician, advanced practice provider, or respiratory therapist; other ventilator/CPAP components and related supplies are not separately reimbursable.

Flushes, diluents and IV solutions

Heparin flushes, saline flushes, IV flushes, sterile water and diluents are considered supplies included in the administration service and are not eligible for separate reimbursement; J1642 (heparin lock flush) is not separately reimbursable as a drug.

Capital equipment

Capital equipment used for multiple patients with extended life is considered a facility fixed asset and is not separately reimbursable; where specific procedure codes exist, those services may be billed appropriately but the equipment itself is not paid separately (examples: cardiac monitor, cautery machines, oximetry monitors, scopes, lasers, IV pumps, thermometers, anesthesia machines, cell saver equipment, microscopes, cameras, rental equipment).

All items, supplies, and services that may be purchased over the counter or are otherwise necessary or integral to a specific service or location are considered routine and included in facility or procedure reimbursement; this list is not all-inclusive.

Coding guidance and specific code rules

Specific coding notesHCPCS | CPT

99070	Supplies and materials provided to the patient over and above those usually included in a service
J1642	Heparin sodium (heparin lock flush), per ten units — not separately reimbursable as drug

Ventilator managementCPTCovered

94002	Ventilator management, initial day
94003	Ventilator management, subsequent day

Ventilator management frequency — billing rules (inv-04)"

Allowed frequencyVentilator management (CPT 94002, 94003) is allowed once per day

Permitted submittersMay be submitted by a physician, an advanced practice provider, or a respiratory therapist

Relevant CPT codesCPT 94002 (initial day) and CPT 94003 (subsequent day)

Billing, documentation, and submission requirements

Documentation Required

Unlisted HCPCS / 99070 — medical records review; prefer HCPCS Level II

When billing an unlisted HCPCS code, medical records will be reviewed prior to claim adjudication. Use a HCPCS Level II code when available; HCPCS Level II codes are preferred over billing under 99070.

Medical records review will occur before adjudication when an unlisted HCPCS code is billed.
Select the most specific HCPCS Level II code available rather than using 99070.

Billing Rule

3-day payment window — include related outpatient services on inpatient claim

Blue KC follows a 3-day payment rule requiring that a hospital (or an entity wholly owned or operated by the hospital) include on the inpatient claim the diagnoses, procedures, and charges for all outpatient diagnostic services and admission-related outpatient nondiagnostic services provided during the payment window.

Definitions of routine services and capital equipment

Routine services — definition & inclusion (inv-07)"},{

Routine services definitionServices integral to the provision of a specific service or to delivery in a specific location that are incorporated into room/board, facility, or ancillary charges and are not separately reimbursable

Examples includedRegular room/observation costs, dietary and nursing services, minor medical and surgical supplies, medical and psychiatric social services, and use of certain equipment and facilities without separate charge

Capital equipment guidanceEquipment used in the provision of services to multiple patients with extended life is considered a fixed asset and is not separately reimbursable

When procedure codes existIf specific procedure codes exist, services provided with that equipment may be billed appropriately (e.g., x-rays, dialysis) per correct coding and billing guidelines