CurrentFlorida BluePolicy 10-021

Supplies

Governs separate reimbursement for HCPCS supply codes and certain CPT supply/procedure codes for Florida Blue members and providers, including facility place-of-service restrictions and Medicare Advantage-specific rules.

Policy Summary

PayerFlorida Blue

PolicySupplies

Policy CodePolicy 10-021

Change TypeAdministrative update

Effective DateJun 29, 2010

Next Review Date

Key ActionDo not bill HCPCS supply codes separately when supplies are provided the same day as an E/M service or procedure in a physician's office.

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 code range

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

A4570-A4590Casting/splint codes not covered (Medicare)

Q4001-Q4051Medicare Advantage Q-codes

99070,99072Referenced CPT supply codes

Separate Reimbursement Criteria

Separate reimbursement criteria for supplies

Florida Blue will not separately reimburse HCPCS supply codes in the following circumstances:

HCPCS supply codes are not separately reimbursable when supplies are provided on the same day as an E/M service and/or procedure performed in a physician's or other health care professional's office.

For services performed in a facility, routine supplies and drugs are included in the payment to the facility and are not separately reimbursable when reported on a CMS-1500 claim form by a physician or other qualified health care professional.

Florida Blue will not allow reimbursement to a physician or other qualified health care professional for routine supplies and drugs reported on a CMS-1500 claim form in the following facility places of service: 19, 21, 22, 23, and 24.

Certain durable medical equipment (DME), orthotics, and prosthetics will not be separately reimbursed when reported by a physician or other qualified health care professional or supplier on a CMS-1500 claim in places of service 19, 21, 22, 23, or 24.

Policy Summary

PayerFlorida Blue

PolicySupplies

Policy CodePolicy 10-021

Change TypeAdministrative update

Effective DateJun 29, 2010

Next Review Date

Key ActionDo not bill HCPCS supply codes separately when supplies are provided the same day as an E/M service or procedure in a physician's office.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Codes and Coding Guidance

HCPCS supply codes (general)HCPCS | mixed

A4000-A8999

General medical and surgical supplies (generally not separately reimbursable)

Casting and splint supplies — Medicare AdvantageHCPCSNot Covered

A4570	Casting and splint supply — not covered for Medicare
A4580	Casting and splint supply — not covered for Medicare
A4590	Casting and splint supply — not covered for Medicare

Casting and splint supplies — Medicare Advantage Q-codesHCPCSCovered

Q4001-Q4051

Q-codes for reimbursement of casting and splint supplies (use for Medicare Advantage)

Physician-supplied materials and public health emergency supplies (CPT)CPT

99070	Supplies and materials provided by physician beyond usual
99072	Additional supplies/materials and clinical staff time during Public Health Emergency

Medicare Advantage casting/splint code requirement

Medicare Advantage casting/splint code requirementFor Medicare Advantage, HCPCS codes A4570, A4580, and A4590 are not covered; use Q4001-Q4051 for reimbursement of casting and splint supplies.

Non‑Medicare Advantage lines of businessProviders may use either A4570-A4590 or Q4001-Q4051 for casting and splint supplies.

RationaleQ codes were established to reimburse physicians and other qualified health care professionals for supplies used in creating casts; Florida Blue Medicare Advantage follows CMS and no longer reimburses A4570-A4590.

Billing and Provider Requirements

Billing Rule

Do not separately bill HCPCS supplies for same-day E/M/procedure or in facility POS 19,21,22,23,24

Do not bill HCPCS supply codes separately when supplies are provided the same day as an E/M service or procedure in a physician's or other health care professional's office; routine supplies and drugs reported on a CMS-1500 for services performed in a facility are included in the facility payment and are not separately reimbursable. Florida Blue will not allow reimbursement to a physician or other qualified health care professional for routine supplies and drugs reported on a CMS-1500 claim form in places of service 19, 21, 22, 23, and 24. Certain DME, orthotics, and prosthetics reported on a CMS-1500 in those POS also will not be separately reimbursed.

Do not separately bill HCPCS supply codes when provided the same day as an E/M service and/or procedure in a physician's or other health care professional's office.
Supplies and drugs reported on a CMS-1500 for facility services are included in the facility payment and not separately reimbursable.
No reimbursement to physicians or other qualified health care professionals for routine supplies/drugs reported on CMS-1500 in POS 19, 21, 22, 23, 24.
Certain DME, orthotics, and prosthetics reported on CMS-1500 in POS 19, 21, 22, 23, 24 will not be separately reimbursed.

Definitions and Inclusions

Routine supplies and drugs included in practice expense RVU or facility payment

Routine supplies included in practice expenseRoutine supplies are incorporated into the practice expense Relative Value Unit (RVU) for the E/M service, diagnostic procedure, or surgical procedure and are not separately reimbursable.

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

Claims reporting implicationDo not expect separate reimbursement for routine supplies reported on CMS-1500 when the service was rendered in a facility setting.