MA PPO

Always Bundled Procedure Codes
MA00.026g

Policy

Refer to the following News Article:
Coverage of Interprofessional Internet Consultation


This policy applies to professional providers billing on a CMS-1500 claim form or the electronic equivalent, 837p, for members enrolled in all Company products.

The procedure codes listed in Attachment A of the policy are always 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.

Guidelines

This policy does not contain an all-inclusive list of procedure codes that may have editing applied to them. Procedure codes not listed in this policy continue to be subject to Company claims adjudication logic, eligibility, benefits, limitations, exclusions, pre-certification/referral requirements, provider contracts, and Company policies.

Description

The Company takes into consideration the Medicare Physician Fee Schedule database (MPFSD) and other appropriate sources.

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 November 26, 2019.

Centers for Medicare and 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 November 26, 2019.


Coding

CPT Procedure Code Number(s)
See Attachment A.

ICD - 10 Procedure Code Number(s)
N/A

ICD - 10 Diagnosis Code Number(s)
N/A

HCPCS Level II Code Number(s)
See Attachment A.

Revenue Code Number(s)
N/A


Coding and Billing Requirements


 

Policy History

1/1/2020
12/31/2019
MA00.026
Claim Payment Policy Bulletin
Medicare Advantage
{"1776":{"Id":1776,"MPAttachmentLetter":"A","Title":"CPT Codes and HCPCS Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85257D39006E7945852584BE0061835A"},}
Yes