CurrentEmpire BluecrossPolicy C-23001

Bundled Services and Supplies - Facility

Defines facility-level services and supplies that are considered bundled and ineligible for separate reimbursement when billed by inpatient and outpatient facilities; applies to providers billing Empire Bluecross commercial facility claims.

Policy Summary

PayerEmpire Bluecross

PolicyBundled Services and Supplies - Facility

Policy CodePolicy C-23001

Change TypeMaterial additions to bundled categories and Related Coding

Effective DateJun 1, 2026

Next Review Date

Key ActionEnsure services meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis.

SourceLink

POLICY UPDATE CHANGES

Added category that will not be allowed for separate reimbursement when billed by a facility provider: Radiology guidance; ultrasonic, fluoroscopic, CT, and MRI; and Travel related vaccinations and administration services.

Added category not allowed for separate reimbursement for facility providers on the same date of service with a room or facility fee: Insertion of bladder catheters.

Added codes 76979, 76983, 77293, 77387 to Related Coding section.

multipleservice/supply categories listed as bundled (non-exhaustive)

10+always-bundled codes in Related Coding

facility claimsbilling context where separate reimbursement is restricted

01/14/2026

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Facility Bundling and Same-date Restrictions

Bundled Facility Services - General Criteria

Facility-billed services and supplies that are 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.

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 (including but not limited to)

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
Radiation guidance: ultrasonic, fluoroscopic, CT, and MRI
Routine supplies and equipment
Travel related vaccinations and administration services

Same-date Restrictions

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 the following categories:

Do not allow separate reimbursement when billed on the same date of service as a room or facility fee, or with another procedure (except the administration service):

Related Coding — Always-bundled Facility Codes

Always-bundled facility codesmixedNot Covered

15851	Removal of sutures or staples requiring anesthesia
76014-76019	MR safety implant and/or foreign body assessment, medical physics examination, or implant electronics preparation and positioning
76979	Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); each additional lesion
76983	Ultrasound, elastography; each additional target lesion
77293	Respiratory motion management simulation
77387	Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking
87913	Infectious agent genotype analysis by nucleic acid (DNA or RNA); SARS-CoV-2 mutation identification in targeted region(s)
96521	Refilling and maintenance of portable pump
96522	Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic
96523	Irrigation of implanted venous access device for drug delivery systems

1–10 of 15

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Authorization, Documentation, and Billing Guidance

Prior Authorization

Authorization and Medical Necessity — Provider Requirements

Prior authorization may be required when the member's benefit plan requires it or when indicated elsewhere in this policy. Services must meet medical necessity criteria and be supported by documentation in the medical record. Obtain authorization prior to rendering services when the plan requires prior authorization; failure to obtain required authorization may result in denial or reduced payment. Ensure documentation clearly describes the clinical indication, procedures performed, relevant diagnostic findings, and rationale linking services to medical necessity.

Verify member eligibility and plan benefits before scheduling services; check for plan-specific prior authorization requirements and any time limits.
When prior authorization is required: include clinical history, relevant diagnostic test results, supporting imaging or pathology reports, and proposed treatment plan in the request.
Document medical necessity: state the diagnosis, symptoms, prior conservative treatments (when applicable), and objective findings that justify the service.
Maintain contemporaneous medical records that fully support billed CPT/HCPCS codes; progress notes, orders, and results should be available on audit.
If services are denied for lack of authorization or insufficient documentation, the provider may be responsible for payment; timely appeal processes should be followed per payer instructions.
Bill using appropriate, industry-standard CPT, HCPCS, and revenue codes; include modifiers only when supported by documentation and coding guidelines.

Key Definitions

Bundled Services — Definitions and related terms

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

ScopeApplies to facility-billed services and supplies reported for inpatient and outpatient facilities when they are integral to a primary service or included in the facility fee.

Related termsAlso referred to in the document as 'Bundled Services' under General Reimbursement Policy Definitions.

Reimbursement impactBundled services are not eligible for separate reimbursement when billed by facility providers; they are considered included in the facility payment.

Clinical examples (illustrative)The policy lists categories and specific codes elsewhere in Related Coding that are designated as always-bundled and not eligible for separate reimbursement.

Policy History and Material Changes

2026-01-14review_approvedLatest

Policy review approved and changes effective 06/01/2026: added radiology guidance (ultrasonic, fluoroscopic, CT, MRI), travel-related vaccinations and administration services, insertion of bladder catheters as a same-date restriction, and added codes 76979, 76983, 77293, 77387 to Related Coding.

2025-11-17review_approved

Policy review approved and effective 04/01/2026: added routine ECG (professional and technical components and supplies) to same-date restrictions and added codes 76014-76019, 96521-96523, 99190-99192, C1734, C1762, C1763, C1781, C1889, and L8699 to Related Coding.

2025-09-24