Highmark Commercial Medical Policy - Pennsylvania |
Medical Policy: | Z-39-015 |
Topic: | Provider Overhead Expenses |
Section: | Miscellaneous |
Effective Date: | October 28, 2013 |
Issue Date: | March 12, 2018 |
Last Reviewed: | February 2014 |
Expenses including, but not limited to, facility/room fees, heat, light, rent, equipment, and office staff are considered part of a provider's overhead expense. |
This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.
Policy Position Coverage is subject to the specific terms of the member’s benefit plan. |
Items considered part of a provider's overhead expense should not be billed separately from professional services.
The cost of supplies (e.g., suture removal kits, surgical trays, electrodes) used in providing a covered professional service is included in the allowance for that professional service and should not be billed separately.
Separate payment will not be made for any overhead expense
These supplies include, but are not limited to, those procedure codes listed below
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The policy position applies to all commercial lines of business |
Denial Statements |
A network provider cannot bill the member for the non-covered service.
Links |
04/2007, Electrodes and related supplies considered overhead expenses
08/2013, Handling and/or conveyance of specimen for transfer from the patient considered overhead expenses