CurrentColorado Rocky Mountain Health PlansPolicy N/A

Hospital inclusive charges (routine services/supplies bundled into room and board/facility charges)

Defines which routine facility services, supplies, equipment and certain ancillary components are considered bundled into room and board, facility or procedure charges and therefore are not separately reimbursable for Colorado Rocky Mountain Health Plans members.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyHospital inclusive charges (routine services/supplies bundled into room and board/facility charges)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionFacilities should expect documentation requests and standard review/audit processes (itemized bill reviews and hospital bill audits) to ensure compliance with the policy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

UB04applies to claims billed on form

All productsapplies to

Revenue codes listedexamples reference revenue codes

1 unit/dayventilator/CPAP consideration

Nursing/respiratory

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Facility bundled services — coverage stance

Facility bundled services criteria

Covered when ALL of the following are met:

Routine services (as defined by CMS and this policy) are included in the room and board, facility, or ancillary service reimbursement and are not separately reimbursable.

Routine medical equipment and supplies that are generally available to all patients (floor stock) are incorporated into the procedure or facility reimbursement and are not separately reimbursable.

Nursing care and respiratory therapist services performed as part of daily responsibilities (bedside nursing, respiratory treatments, certified nursing assistants, perfusionists, technicians) are included in room and board charges and are not eligible for separate reimbursement.

Charges for surgical rooms and associated supplies/equipment (including items referenced to revenue codes 270-279 and 300-370) are bundled into the surgical room/service charge and are not separately reimbursable.

Management of a facility-owned ventilator or CPAP may be considered for reimbursement at a rate of one (1) unit per day; ancillary components may be separately reimbursable but routine components integral to delivery are not separately reimbursed.

Operational note: Lists of items and revenue codes are illustrative, not exhaustive; UnitedHealthcare applies CMS guidance and industry coding sources to identify bundled items. Policy applies to services reported on UB-04 (or electronic equivalent) for all products and facility claims.

Revenue codes, examples, and equipment units

Example revenue code groups referencedRevenue

250-279	Example revenue code ranges for medical/surgical supplies and surgical rooms
260-269	Revenue codes associated with routine medical equipment/supplies and nursing
300-370	Surgical room and related service revenue codes
410-419	Respiratory/ventilator-related revenue codes

Ventilator/CPAP units per day

Reimbursement thresholdOne (1) ventilator or CPAP unit per day will be considered for reimbursement when the device is facility-owned.

Ancillary componentsCertain services ancillary to ventilator/CPAP usage may be separately reimbursable, but routine components integral to delivery are not separately reimbursed.

Examples of non-reimbursable componentsSystem set up, system checks, circuit change, respiratory assessment, tracheostomy supplies and care, CO2 end tidal system setup/monitoring, O2/CPAP/PEEP changes, endotracheal suctioning, weaning, extubating are listed as routine components and not separately reimbursable.

Documentation, audit and billing expectations

Note

Key term definitions for bundled items

Routine services — definition and bundling

Definition (routine services)Routine services encompass regular room/observation costs, dietary and nursing services, minor medical and surgical supplies, medical and psychiatric social services, and the use of certain equipment and facilities without a separate charge.

Bundling ruleRoutine services are incorporated into the room and board, facility, or ancillary service charge and are not eligible for separate reimbursement.

Scope examplesIncludes services provided in standard rooms and special care units (e.g., CCU, ICU) and routine aspects of ancillary services that will not be separately reimbursed.

Floor stock / routine supplies

Floor stock definitionItems generally available to all patients (basic supplies and equipment) that are incorporated into the overall reimbursement of the procedure or facility charge and not separately reimbursable.