CurrentFlorida BluePolicy 10-021

Supplies — HCPCS supply code reimbursement

Defines Florida Blue's reimbursement stance for HCPCS supply codes and certain CPT codes when supplies are provided with evaluation/management, diagnostic, or surgical services and identifies places of service where separate reimbursement is not allowed. Applies to Florida Blue lines of business and providers.

Policy Summary

PayerFlorida Blue

PolicySupplies — HCPCS supply code reimbursement

Policy CodePolicy 10-021

Change TypeClarified (operational link added)

Effective DateOct 9, 2025

Next Review Date

Key ActionDo not bill HCPCS supply codes separately when supplies are provided the same day as an E/M service, diagnostic procedure, or surgical procedure; routine supplies in specified facility settings are included in facility payment and not separately reimbursable.

SourceLink

POLICY UPDATE CHANGES

Link to a list of HCPCS supply codes that will not be reimbursed in POS 19, 21, 22, 23, or 24 was added to the policy.

A4000-A8999HCPCS supply range

POS 19,21,22,23,24Non-reimbursed POS

99070,99072CPT considered included

Q4001-Q4051Recommended Q-codes

Policy ID 10-021

Policy Summary

PayerFlorida Blue

PolicySupplies — HCPCS supply code reimbursement

Policy CodePolicy 10-021

Change TypeClarified (operational link added)

Effective DateOct 9, 2025

Next Review Date

SourceLink

On This Page

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Supply Reimbursement Coverage Criteria

Coverage criteria for supply reimbursement

When supplies are provided on the same day as services or in specified facility settings, separate reimbursement is restricted as follows:

Operational note: a link to the list of HCPCS supply codes that will not be reimbursed when reported by a physician in POS 19, 21, 22, 23, or 24 was added to the policy.

Supply and Related Codes

HCPCS Supply CodesHCPCS

A4000-A8999	Medical and surgical supply HCPCS codes
A4570	Casting and splint supply (not covered for Medicare Advantage)
A4580	Casting and splint supply (not covered for Medicare Advantage)
A4590	Casting and splint supply (not covered for Medicare Advantage)
Q4001-Q4051	Q-codes for reimbursement of casting and splint supplies (use for Medicare Advantage)

CPT Supply and Related CodesCPT

99070	Supplies and materials provided by physician over and above usual office visit
99072	Additional supplies/materials and clinical staff time during a Public Health Emergency

Facility POS inclusion — supplies and drugs included in facility payment

Policy statementWhen services are performed in a facility and supplies or drugs are reported on a CMS-1500 by a physician or other qualified health care professional, those routine supplies and drugs are included in the facility payment and are not separately reimbursable.

Applicable code rangeMedical and surgical supplies are generally identified by HCPCS codes A4000–A8999.

Related procedure guidanceProcedure codes 99070 and 99072 are considered B-status / included in other services and not separately reimbursable.

Cross-referenceSee Florida Blue Payment Policy 10-004 (B-Status codes) for additional guidance on procedures included in other services.

Provider Billing Actions and Restrictions

Billing Rule

Do not separately bill HCPCS supply codes with same-day services

Do not bill HCPCS supply codes separately when supplies are provided on the same day as an E/M service, diagnostic procedure, or surgical procedure; for services performed in a facility, routine supplies and drugs are included in the facility payment and are not separately reimbursable when reported on a CMS-1500 by a physician or other qualified health care professional.

Medical and surgical supplies are generally identified by codes A4000-A8999.
Procedure codes 99070 and 99072 are considered B-status and are included in other services (see Payment Policy 10-004).
Florida Blue will not allow separate reimbursement to a physician or other qualified health care professional for routine supplies and drugs reported on a CMS-1500 in POS 19, 21, 22, 23, and 24.

Billing Rule

Use Q4001–Q4051 (not A4570–A4590) for casting/splint supplies on Medicare Advantage

Definitions and Places of Service

Routine supplies — definition

DefinitionRoutine supplies are supplies whose cost is incorporated into the practice expense Relative Value Unit (RVU) for E/M services, diagnostic procedures, or surgical procedures and therefore are not separately reimbursable.

When includedThese supplies are considered included when provided on the same day as an E/M service, diagnostic procedure, or surgical procedure.

Facility reporting impactIf the supplies are provided in a facility and reported on a CMS-1500 by a physician or other qualified health care professional, they are included in the facility payment and not separately reimbursable.

Typical HCPCS rangeMedical and surgical supply HCPCS codes are generally in the A4000–A8999 range.

Places of Service where separate reimbursement is not allowed

Restricted POS