Unbundling (also known as fragmentation) is the billing of multiple procedure codes for a group of procedures normally covered by a single, comprehensive CPT code. An example of unbundling is billing parts of a single, whole procedure separately.
HMSA pays for comprehensive services involving multiple procedures based on the single procedure code applicable to the group of procedures.
Claims Filing Information
For all claims, providers should bill only the appropriate code(s).
Example 1
| Claim contains: | |
|---|---|
| 93000 | Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report |
| 93015 | Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report |
HMSA will:
Recognize code 93015 only. Services rendered during a cardiovascular stress test include the ECG and other related services.
Example 2
| Claim contains: | |
|---|---|
| 58150 | Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(ies) |
| 49000 | Exploratory laparotomy, exploratory celiotomy with or without biopsy(ies) (separate procedure) |
| 58720 | Salpingo-oophorectomy, compete or partial, unilateral or bilateral (separate procedure) |
HMSA will:
Recognize code 58150 only. Services rendered during a total abdominal hysterectomy include those listed under 49000 and 58720.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |