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Policy Attachment

00.01.52w
A
00.01.52w
Always Bundled Procedures (Indicator B)
Always Bundled Procedure Codes


Always Bundled Procedure and Services

Procedur​e Code​

0537T
0538T
0539T
20930
20936
22841
34839
36000
36416
38204
90885
90887
90889
92352
92353
92354
92355
92358
92371
92531
92532
92533
92534
92605
92606
92618
92921
92925
92929
92934
92938
92944
93740
93770
94005
94150
96902
97010
97602
98960
98961
98962
99000
99001
99002
99024
99050
99051
99053
99056
99058
99060
99070
99071
99072

99078
99080
99100
99116
99135
99140
99288
99366
99367
99368
99374
99377
99379
99380
99485
99486
A4262
A4263
A4270
A4300
A4550
G0269
G0501
Q3031
R0076​


10/01/2024
10/15/2024
N/A
Claim Payment Policy Bulletin
Commercial
7c1789be-016d-4e2a-8483-612f267ce5d6
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