CurrentUnitedHealthcarePolicy N/A

Hospital inclusive charges (bundled room/facility charges)

Defines items, supplies, equipment and routine services that are considered included in the facility room/board or procedure charge and therefore are not separately reimbursable for UnitedHealthcare Community Plan Medicaid products billed on UB-04 (or electronic equivalent). Affects network and non-network facilities submitting inpatient or outpatient facility claims.

Policy Summary

PayerUnitedHealthcare

PolicyHospital inclusive charges (bundled room/facility charges)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionExpect documentation requests and potential itemized bill reviews and hospital bill audits as part of standard review processes.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

UB-04claim form coverage

Community Plan Medicaidproduct scope

260-269;270-279;300-370;410;412;419;460revenue code ranges

1 unit/dayventilator/CPAP note

NC listedstate exceptions

Policy Summary

PayerUnitedHealthcare

PolicyHospital inclusive charges (bundled room/facility charges)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionExpect documentation requests and potential itemized bill reviews and hospital bill audits as part of standard review processes.

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.

Items Included in Facility (Bundled) Charges

The following categories and examples describe items and services that are considered routine or bundled into the facility/room/surgical suite charge and are not eligible for separate reimbursement. These examples are illustrative, not exhaustive.

ALL of the following

Routine supplies and equipment (floor stock)
- Sterile supplies and surgical instruments (e.g., biopsy forceps, implanted medical devices).
  Often associated with revenue codes 260-269, 270, 279, 410, 412.
- Non-sterile supplies (e.g., stethoscopes, bandages, diagnostic kits, general medical instruments).
- Single-use and reusable items commonly maintained as floor stock (e.g., basin, batteries, thermometers, cold/hot packs).
IV and infusion-related items
- IV therapy and IV infusion pumps (including pumps such as IV, syringe, blood warmer, suction, feeding, PCA).
- IV solutions and flushes (e.g., IV saline, heparin flushes) and IV tubing and related specimen collection tubing.
- IV pharmacy services and routine administration of IV fluids when part of nursing/room care.
Nursing and routine clinical care services provided by bedside staff
- Direct nursing care by RN/LPN, respiratory therapists, CNAs, perfusionists or technicians as part of daily responsibilities (includes monitoring vital signs, cardiac monitoring, fluid/specimen collection, personal hygiene, tracheostomy care).
- Medication administration (including blood/blood products), basic medication preparation/dispensing, IV/PICC line insertion and maintenance, venipuncture/arterial stick, wound care and dressing changes).
- Assisting physician with procedures, routine documentation, and incremental nursing care associated with room/board or critical care daily charges.
Surgical room / procedure suite bundled items and services
- Surgical supplies and equipment used in operating, procedure, endoscopy, cath, and treatment rooms (e.g., anesthesia equipment and gases, monitors, laparoscopes, bronchoscopes, endoscopes, fluoroscopy/C-arm and accessories).
- Surgical instruments and disposables (e.g., drill bits, saws, blades, grounding pads, hemochron supplies).
- Ancillary devices and accessories used during procedures (e.g., surgeons’ loupes, video camera equipment, suction, saline infusion, local anesthesia applied as routine).
Respiratory and ventilator-related components
- Facility-owned ventilator or CPAP management considered for reimbursement as one unit per day; however routine components are bundled and not separately reimbursed.
- Routine ventilator/CPAP components and activities not separately reimbursable: system set up, system checks, circuit changes, respiratory assessment, endotracheal suctioning, weaning/extubating, tracheostomy supplies and care, CO2/end tidal monitoring setup; associated routine supplies (revenue codes 410, 412, 419, 460).
Other specific supply examples typically bundled
- Fetal monitors, perfusion equipment and supplies, pumps, blood pressure equipment, humidifiers, CPAP machines, breast pumps, scales, beds, commodes, overhead frames.
- Small consumables and clinical items (e.g., alcohol swabs/pads, bandages/dressings, mouth care kits, bedpans, oxygen masks/cannula/tubing, specimen collection kits such as arterial blood gas or urine collection).

Revenue Codes and Unit Rules

Revenue code groups referenced as bundledmixedCovered

revenue 260-269	Sterile/non-sterile supplies, perfusion equipment, pumps, beds, monitors and similar floor stock
revenue 270-279	Surgical room items, anesthesia equipment, robotic techniques, laparoscopes, scopes
revenue 300-370	Surgical rooms and related charges
revenue 410, 412, 419, 460	Respiratory/ventilator related supplies and assessments

Ventilator/CPAP facility‑owned units — reimbursement note

Reimbursement allowanceCharges for management of a facility‑owned ventilator or CPAP will be considered for reimbursement at one (1) unit per day.

Ancillary servicesCertain ancillary services related to ventilator or CPAP usage may be separately reimbursable, but routine components integral to delivery are not separately reimbursed.

ScopeApplies to ventilator/CPAP units owned by the facility (not patient‑owned equipment) billed on the facility claim.

Documentation, Audit and Billing Expectations

Documentation Required

Documentation and audit expectations

Facilities must maintain and provide complete, accurate documentation to support billed services. UnitedHealthcare may request supporting records, including but not limited to itemized bills, medical records, operative reports, and charge detail, to verify that charges are included or excluded per policy. Respond promptly to documentation requests to avoid delays or denials.

Itemized bill reviews and hospital bill audits may be performed to confirm that certain items are not separately reimbursable because they are included in room & board or an underlying procedure.
Documentation should clearly link charges to the corresponding encounter, dates of service, and billed codes; include quantity/unit detail and any modifiers where applicable.
Keep records of communications and submissions in case of follow-up audits or appeals.

Definitions and Routine Items

Routine services — definition

DefinitionUnitedHealthcare incorporates CMS's Provider Reimbursement Manual definition: 'Routine services' encompass regular room/observation room costs, dietary and nursing services, minor medical and surgical supplies, medical and psychiatric social services, and the use of certain equipment and facilities without a separate charge.'

Inclusion in room/facility chargeRoutine services are incorporated into the reimbursement for the room and board charge, facility charge, or ancillary service charge and are not eligible for separate reimbursement.

ExamplesIncludes dietary and nursing services, minor medical and surgical supplies, medical/psychiatric social services, and use of certain equipment and facilities without separate charge.

Routine medical equipment and supplies — floor stock and incorporated items

Floor stock definitionRoutine medical equipment and supplies are generally available to all patients receiving services and are considered floor stock incorporated into the overall procedure or facility reimbursement.