Highmark Medical Policy Bulletin
Section: Miscellaneous
Number: Z-39
Topic: Provider Overhead Expenses
Effective Date: August 28, 2000
Issued Date: August 28, 2000
Date Last Reviewed: 05/1998

General Policy Guidelines

Expenses such as facility/room fees, heat, light, rent, equipment, and office staff are considered part of a provider's overhead expense and should not be billed separately from his or her professional services.

Additionally, supply charges such as, but not limited to, those listed below are also considered part of a provider's overhead expense and should not be billed separately from his or her professional services:

A4220 - Refill kit for implantable infusion pump
A4262 - Temporary, absorbable lacrimal duct implant, each
A4263 - Permanent, long term, non-dissolvable lacrimal duct
implant, each
A4270 - Disposable endoscope sheath, each
A4550 - Surgical trays

Separate payment will not be made for any overhead expense and a participating provider may not bill the patient for these expenses.

Note: Exceptions to coverage for overhead expenses are identified in the individual group's benefits.

Procedure Codes

A4220A4262A4263A4270A4550 

Traditional (UCR/Fee Schedule) Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Refer to General Policy Guidelines

Comprehensive/Wraparound/PPO Guidelines

Refer to General Policy Guidelines

Managed Care (HMO/POS) Guidelines

Refer to General Policy Guidelines

Publications

PRN References

03/1994, Provider Overhead Expenses, reimbursement for
06/1996, Overhead Expenses, codes and reimbursement for

References

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Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect Highmark's reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.

Highmark retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.