Commercial

Medical Policy

Notification

Always Bundled Procedure Codes

Notification Issue Date:

This version of the policy will become effective 04/12/2021. This has been updated to communicate the reimbursement position of all services not eligible for reimbursement or not eligible for separate reimbursement by the Company. Attachments B and C have been introduced to this policy to represent services that are not eligible for separate reimbursement or not eligible for reimbursement and were previously communicated in other policies.

The following criteria have been added to the policy:

The procedure codes listed in Attachment B may be covered by the Company; however, are not eligible for separate reimbursement consideration whether billed alone or in conjunction with other services. Participating providers may not bill members for these services.
The procedure codes listed in Attachment C may be covered by the Company; however, they are not eligible for reimbursement consideration. Participating providers may not bill members for these services.

The following CPT code has been added to this policy in attachment B and is not eligible for separate reimbursement. This position was previously communicated in other policies:

92285

Title:

Always Bundled Procedure Codes

Policy #:

00.01.52v

Policy

This policy applies to professional and outpatient facility claims.

The procedure codes listed in Attachment A are considered "always bundled", based on the Medicare Physician Fee Schedule Database (MPFSD) Status B Indicator. These procedure codes are considered bundled into the reimbursement for other services and, therefore, are not eligible for separate reimbursement, whether billed alone or in conjunction with other services. Participating providers may not bill members for these services.

The procedure codes listed in Attachment B may be covered by the Company; however, they are not eligible for separate reimbursement consideration whether billed alone or in conjunction with other services. Participating providers may not bill members for these services.

The procedure codes listed in Attachment C may be covered by the Company; however, they are not eligible for reimbursement consideration. Participating providers may not bill members for these services.

Guidelines

Inclusion of a code in this policy does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

Description

The intent of this policy is to communicate services that are not eligible for reimbursement or not eligible for separate reimbursement consideration by the Company.

The Company takes into consideration the Medicare Physician Fee Schedule Database (MPFSD), the American Medical Association Current Procedure Technology (CPT) Manual, Centers for Medicare & Medicaid Services (CMS) guidelines, Company policies, and other appropriate sources, when determining services listed in this policy.

The MPFSD identifies procedure codes with the status B indicator. The status B indicator is used when the reimbursement for certain procedure codes is always considered bundled into the reimbursement for other services.

References

Centers for Medicare & Medicaid Services (CMS). National Physician Fee Schedule Relative Value File. [CMS Web site]. Available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html. Accessed December 15, 2020.

Centers for Medicare & Medicaid Services Medicare Claims Processing Manual. Chapter 23 - Fee Schedule Administration and Coding. Requirements. Table of Contents. (Rev. 4188, 12-28-18). Available at:http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c23.pdf. Accessed December 15, 2020.

Company Benefit Contracts.

Coding

CPT Procedure Code Number(s)

Attachment A: Always Bundled Procedures/Services (MPFSD) Status B Indicator

Attachment B: Procedures/Services Not Eligible for Separate Reimbursement

Attachment C: Procedures/Services Not Eligible for Reimbursement

ICD - 10 Procedure Code Number(s)

N/A

ICD - 10 Diagnosis Code Number(s)

N/A

HCPCS Level II Code Number(s)

Attachment A: Always Bundled Procedures/Services (MPFSD) Status B Indicator

Attachment B: Procedures/Services Not Eligible for Separate Reimbursement

Attachment C: Procedures/Services Not Eligible for Reimbursement

Revenue Code Number(s)

N/A

MPMiscCodesNarrativesPub

Coding and Billing Requirements

Cross Reference

Policy History

Version Effective Date:

7/1/2024

Version Issued Date:

7/8/2024

Version Reissued Date: