Items and services that are considered inclusive to the room/facility or ancillary charge and therefore not eligible for separate reimbursement include, but are not limited to, the following categories and examples.
Routine medical equipment and supplies: floor-stock items generally available to all patients and incorporated into the procedure or facility reimbursement (examples: sterile and non-sterile supplies, perfusion equipment, anesthesia/bladder/CPAP machines, pumps, beds, fetal monitors).
Medical/surgical supplies and small disposables: examples include alcohol swabs/pads, bandages/dressings, batteries, bedpans, cold/hot packs, heat lights or pads, thermometers, IV solutions and flushes, IV/ blood tubing, specimen collection kits (e.g., ABG kits, urine collection), breast pumps—these items are included in the room or facility charge and are not separately reimbursable.
Nursing care and related services: bedside nursing (RN/LPN), respiratory therapists, certified nursing assistants, perfusionists and other technicians performing routine duties — medication administration, monitoring vital signs and cardiac monitors, venipuncture, catheterization, IV/PICC insertion and maintenance, tracheostomy care, personal hygiene, fluid/specimen collection, dispensing/preparing medication, respiratory treatments, point-of-care testing, and documentation — are incorporated into the room/board or service charge and are not eligible for separate reimbursement.
Surgical suite and procedural room inclusions: items and services associated with surgical rooms and service charges (examples: anesthesia equipment, monitors and gases, intubation/extubation, cardiac monitors, cardiopulmonary bypass equipment, laparoscopes/bronchoscopes/endoscopes and accessories, fluoroscopy/C-arm equipment, grounding pads, surgical instruments and accessories, robotic-assisted technique components) are included in the surgical room/service charge and are not separately reimbursable.
Ventilator/CPAP management: charges for facility-owned ventilator or CPAP will be considered for reimbursement at one unit per day; routine components related to ventilator/CPAP care (system setup, system checks, circuit changes, respiratory assessment, tracheostomy supplies and care, endotracheal suctioning, weaning, extubation, CO2 end tidal setup/monitoring, O2/PEEP/CPAP changes) are not separately reimbursable though certain ancillary services may be separately reimbursable when not routine.
Review and audit: UnitedHealthcare may review claims, request documentation, and perform itemized bill reviews and hospital bill audits to ensure compliance with this policy.
Notes: This policy addresses inclusions to room/facility charges and does not address professional charges; UnitedHealthcare Medicare Advantage may modify the policy to align with CMS or national coding guideline changes and the policy does not denote prior authorization requirements.