CurrentOscar HealthPolicy N/A

Routine Services, Supplies, and Equipment — Reimbursement for supplies, DME, orthotics, prosthetics and related HCPCS/CPT codes

Governs Oscar Health reimbursement methodology for supplies, drugs, DME, orthotics, prosthetics and related HCPCS/CPT codes by place of service; affects providers billing Oscar Health (excludes Home Health and POS 12).

Policy Summary

PayerOscar Health

PolicyRoutine Services, Supplies, and Equipment — reimbursement guidance for supplies, DME, orthotics, prosthetics and related codes

Policy CodePolicy N/A

Change TypeNon‑material editorial revision (added CPT 99072)

Effective Date06/2021

Next Review Date2025-06

Key ActionDo not separately bill CPT 99070 and 99072 or designated HCPCS supply codes when provided the same day as an E/M or procedure in non‑facility places of service.

SourceLink

POLICY UPDATE CHANGES

Removed specific code sets and ensured verbiage is current; added Supply code 99072.

24Non-facility POS codes

5Facility POS codes

31SNF POS

99070/99072Not separately reimbursable

Separate Reimbursement Criteria

Policy Summary

PayerOscar Health

PolicyRoutine Services, Supplies, and Equipment — reimbursement guidance for supplies, DME, orthotics, prosthetics and related codes

Policy CodePolicy N/A

Change TypeNon‑material editorial revision (added CPT 99072)

Effective Date06/2021

Next Review Date2025-06

Key ActionDo not separately bill CPT 99070 and 99072 or designated HCPCS supply codes when provided the same day as an E/M or procedure in non‑facility places of service.

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.

Separate Reimbursement Criteria

Oscar will not separately reimburse certain supplies and related HCPCS/CPT codes under the following conditions:

Claims for Home Health Care and DME providers reporting place of service 12 (home) are outside the scope of this policy and not governed by the separate reimbursement criteria in this document.

Certain HCPCS supply codes and CPT codes 99070 and 99072 are considered part of the primary E/M service or procedure and will not be separately reimbursed when those supplies are provided on the same day as an E/M service and/or procedure performed in a non-facility place of service by a physician or other qualified healthcare professional.

Supplies, durable medical equipment (DME), orthotics, prosthetics and biologicals reported by a physician or other qualified healthcare professional in a facility place of service are considered packaged into facility payments (per CMS Prospective Payment System and DMEPOS methodology) and will not be separately reimbursed.

Oscar’s reimbursement follows CMS guidance (PPS and DMEPOS fee schedule); when CMS packages supply/DME/orthotics/prosthetics/biological costs into facility or DMEPOS payments, Oscar will treat these items as not separately reimbursable in the corresponding facility POS (including skilled nursing facility POS 31 and nursing facility POS 32).

Codes and Same-day Bundling Rules

Supply codes not separately reimbursableCPTNot Covered

99070	Supplies and materials (except spectacles), e.g., dressing, sterile supplies
99072	Additional supplies and time for safety protocols (added to policy as not separately reimbursable)

Same-day bundling threshold - inv-03

ThresholdSupply HCPCS codes (and CPT 99070/99072) provided on the same day as an E/M service or procedure in a non-facility POS by a physician or other qualified healthcare professional will not be reimbursed separately.

ScopeApplies when supplies are provided on the same day as an E/M service and/or procedure in non-facility places of service.

ReasoningCosts of certain supplies are considered incorporated into the E/M or procedure code and therefore bundled with the primary service.

Billing and Submission Rules

Billing Rule

Do not separately bill 99070/99072 or bundled supply HCPCS

Do not separately bill CPT 99070 or 99072, or certain HCPCS supply codes, when those supplies are provided the same day as an E/M service or procedure in a non-facility place of service; supplies, DME, orthotics, prosthetics and biologicals reported in facility POS are packaged into facility payments and are not separately reimbursable.

CPT 99070 and 99072 are not separately reimbursable and are considered part of the primary procedure when performed the same day.
Certain HCPCS supply codes are not separately reimbursable when provided the same day as an E/M service and/or procedure by a physician or other qualified healthcare professional in a non-facility POS.
Supplies, DME, orthotics, prosthetics and biologicals submitted by a physician or other healthcare professional in a facility POS (including SNF POS 31 and Nursing Facility POS 32) are considered packaged into facility PPS/DMEPOS payments and not separately reimbursable.

Place of Service (POS) Definitions

Non-Facility POS - inv-05

DefinitionNon-Facility Place of Service codes: 1, 3, 4, 9, 11, 13, 14, 15, 16, 17, 20, 33, 49, 50, 54, 55, 57, 60, 62, 65, 71, 72, 81, 99.

ContextThese POS codes designate settings where Oscar will apply same-day bundling of supply codes with E/M or procedure services.

Policy impactSupplies provided in these POS are subject to the non-separate reimbursement rule when furnished the same day as an E/M or procedure by a physician or qualified healthcare professional.

Facility POS - inv-06

DefinitionFacility Place of Service codes: 19, 21, 22, 23, 24.

ContextServices and supplies reported in these facility POS are considered within facility PPS payments and not reimbursed separately when applicable.

Relation to reimbursementDME, orthotics, prosthetics and related supplies reported by physicians in these POS are treated as packaged into facility payments per CMS PPS methodology.

Skilled Nursing Facility POS - inv-07

DefinitionSkilled Nursing Facility Place of Service: 31.

Policy notePayments for supplies, DME, orthotics, prosthetics and biologicals in SNF (POS 31) are considered included in facility payments and not separately reimbursed when reported by a physician or qualified healthcare professional.

CMS alignmentOscar follows CMS PPS and DMEPOS fee schedule guidance for SNF POS treatment of supplies and equipment.

Nursing Facility POS - inv-08

DefinitionNursing Facility Place of Service: 32.

Policy noteSupplies and DME reported in Nursing Facility (POS 32) are generally considered packaged into facility payments and not separately reimbursed when billed by a physician or qualified healthcare professional.

CMS alignmentOscar aligns with CMS PPS/DMEPOS guidance for nursing facility reimbursement treatment.