Bundled Services and Supplies (State Health Programs)
Provider Type
- Physicians
Services and supplies that are covered but considered included in a related service are denied or bundled into the payment for the related service. Health Net follows the Centers for Medicare and Medicaid Services (CMS) bundled services policy with some exceptions.
The following codes are exempt from the CMS bundled services rule. These codes are classified as always bundled by CMS; however, they are not routinely bundled by Health Net. (These codes may be subject to bundling policies outside of the CMS bundled services rule.)
- 36416: Collection of capillary blood
- 99070: Supplies and materials (non-routine only)
- 99100: Anesthesia for extreme age
- 99116: Anesthesia with hypothermia
- 99135: Anesthesia with controlled hypotension
- 99140: Anesthesia complicated by emergency conditions
- 99358: Prolonged physician service; first hour
- 99359: Prolonged physician service; each additional 30 minutes
Health Net considers other services that are not part of the CMS bundled services policy as always included in a more primary procedure.
Health Net does not require documentation at the time of claim submission; however, in the event the claim is audited, documentation may be required.
Supporting Sources
- CMS National Policy