Supplies

HMSA considers routine physician-office supplies to be overhead expense and does not pay physicians for such incidental supplies (e.g., gloves, syringes, swabs and bandages). Participating providers may not bill members for these supplies. However, HMSA will consider separate payment for non-routine supplies, such as splints, cast supplies and special casting material. These supplies should be billed using the appropriate HCPCS codes.

Claims Filing Information

Claims for routine or incidental supplies and materials should not be billed. Generic codes for supplies, such as 99070 and A4649, will not be recognized and should not be used. Use of these codes will cause your claims for miscellaneous supplies to be denied.

Example 1

Claim contains:

90732 - Pneumococcal immunization

90471 - Immunization

A4245 - Alcohol wipes

A6402 - Gauze pad, sterile

HMSA will:

Pay for procedure code 90732 and 90471 only. HMSA does not recognize A4245 and A7402 because the supplies are considered part of overhead and should not be billed separately.

Example 2

Claim contains:

99213 - Office visit

99070 - Supplies (custom fabricated wrist brace)

99072 - Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other nonfacility service(s), when performed during a Public Health Emergency, as defined by law, due to respiratory-transmitted infectious disease

HMSA will:

Pay for the office visit only, because HMSA does not recognize miscellaneous supplies code 99070 and 99072. Routine supplies are considered incidental and part of overhead and will not be paid separately. However, non-routine supplies, such as a wrist brace, will be paid separately if billed using the appropriate HCPCS codes. In this example, the brace would be paid if coded as L3906.

Revision History