Bundled Services and Supplies - Facility
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Governs which services and supplies billed by inpatient and outpatient facility providers are ineligible for separate reimbursement (considered bundled into facility or room fees) for Empire Bluecross commercial plans.
Added categories not allowed for separate reimbursement for facility providers on the same date of service with a room or facility fee, including Routine ECG professional and technical component and supplies.
Added Blood products; splitting, pooling, and thawing and Blood Product administration language and related codes.
Added numerous CPT/HCPCS codes to the Related Coding section that are considered not eligible for reimbursement.
Bundling Rules for Facility Providers
Bundling criteria for facility providers
Services and supplies 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. No modifiers will override denials for always-bundled items.
Categories considered 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
- Routine supplies and equipment
Not separately reimbursable on same date as room/facility fee or procedure
- Blood Product administration
- Chemotherapy administration
- Infusion Drug administration
- Routine ECG; professional and technical component and supplies
Specific CPT/HCPCS codes always bundled (see Related Coding for full list)
- 76014-76019 (MR safety implant/foreign body assessment and related services) - Not eligible for reimbursement
- 87913 (Infectious agent genotype analysis for SARS‑CoV‑2 mutation identification) - Not eligible for reimbursement
- 97010 (application of modality; hot or cold packs) - Not eligible for reimbursement
- 99070 (supplies and materials provided over and above those usually included) - Not eligible for reimbursement
- 99190-99192 (assembly and operation of pump with oxygenator or heat exchanger) - Not eligible for reimbursement
- G0498 (chemotherapy administration initiation in office/clinic) - Not eligible for reimbursement
- G2211 (visit complexity inherent to E/M associated with ongoing care) - Not eligible for reimbursement
- K1034 (provision of nonprescription self‑administered COVID‑19 test) - Not eligible for reimbursement
- L8699 (prosthetic implant, not otherwise specified) - Not eligible for reimbursement
- T1040 (Medicaid certified community behavioral health clinic services, per diem) - Not eligible for reimbursement
Refer to the Related Coding section for the complete enumerated list of CPT and HCPCS codes considered always bundled and not eligible for reimbursement.
Codes Not Eligible for Separate Reimbursement
| 15851 | Removal of sutures or staples requiring anesthesia - Not eligible for reimbursement |
| 76014-76019 | MR safety implant and/or foreign body assessment, medical physics examination, or implant electronics preparation and positioning by trained clinical staff, physician or other qualified health care professional - Not eligible for reimbursement |
| 87913 | Infectious agent genotype analysis by nucleic acid (DNA or RNA); SARS-CoV-2 mutation identification in targeted region(s) - Not eligible for reimbursement |
| 96521 | Refilling and maintenance of portable pump - Not eligible for reimbursement |
| 96522 | Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic (eg, intravenous, intra-arterial) - Not eligible for reimbursement |
| 96523 | Irrigation of implanted venous access device for drug delivery systems - Not eligible for reimbursement |
| 97010 | Application of a modality; hot or cold packs - Not eligible for reimbursement |
| 99070 | Supplies and materials provided by physician over and above those usually included - Not eligible for reimbursement |
| 99190-99192 | Assembly and operation of pump with oxygenator or heat exchanger - Not eligible for reimbursement |
| C1734 | Orthopedic/device/drug matrix for opposing bone-to-bone or soft tissue-to-bone (implantable) - Not eligible for reimbursement |
Billing, Authorization, and Documentation Guidance
Billing, Authorization, and Documentation Requirements
Use industry-standard CPT, HCPCS, and revenue codes on all claim submissions; codes must accurately denote services performed and be fully supported in the medical record and/or office notes. Services billed must meet authorization and medical necessity guidelines and member benefit terms; failure to follow coding, billing, authorization, or medical necessity requirements may result in claim rejection, denial, or recovery/recoupment.
- Bill services with CPT, HCPCS, and/or revenue codes that reflect the services rendered and are documented in the medical record.
- Ensure services meet authorization and medical necessity requirements and are consistent with the member’s benefit plan.
- Noncompliance may lead to claim rejection/denial or recovery/recoupment.
Key Definitions
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