UniCare Bundled Services and Supplies Section 1 Coding 02/07/2017
This table is provided as an informational tool only to help identify some examples of the services and
supplies described in Policy Section 1 of the Bundled Services and Supplies reimbursement policy. The
exclusion of a specific code does not indicate eligibility for reimbursement under all circumstances.
0001F-9007F
0185T
0358T
15850
20930
20936
22841
34839
44705
76376
76377
80320-80377
83992
84112
90889
92921
92925
92929
92934
92938
92944
93770
94005
94760
94761
97010
98960
98961
98962
98966-98969
99000
99001
99002
99024
99026
99027
99053
99056
99058
99060
99070
RP0008 Bundled Services and Supplies Section 1 Code List
Page 1 of 5
UniCare Bundled Services and Supplies Section 1 Coding 02/07/2017
This table is provided as an informational tool only to help identify some examples of the services and
supplies described in Policy Section 1 of the Bundled Services and Supplies reimbursement policy. The
exclusion of a specific code does not indicate eligibility for reimbursement under all circumstances.
99090
99091
99339
99340
99356-99359
99360
99366
99367
99368
99374
99377-99380
99415
99416
99441
99442
99443
99487-99490
99495-99498
A4216
A4218
A4262
A4263
A4264
A4270
A4300
A4470
A4480
A4550
A4649
A4650
A9279
A9901
C1300-C9899
*exception C9257
G0151-G0164
G0180
G0269
G0276
G0299
G0300
G0390
RP0008 Bundled Services and Supplies Section 1 Code List
Page 2 of 5
UniCare Bundled Services and Supplies Section 1 Coding 02/07/2017
This table is provided as an informational tool only to help identify some examples of the services and
supplies described in Policy Section 1 of the Bundled Services and Supplies reimbursement policy. The
exclusion of a specific code does not indicate eligibility for reimbursement under all circumstances.
G0452
G0466-G0470
G0472
G0473
G0498
G0500
G0501
G0502-G0507
G0913-G0918
G8216G8977
G8978-G8999
G9140
G9158
G9186
G9187
G9473-G9479
G9481-G9490
G9678
H0048
J1642
P9603
P9604
Q0511
Q0512
Q0513
Q5001
Q5002
Q5009
Q9977
S0221
S0257
S0270-S0274
S0280
S0281
S0302
S0310
S0315-S0317
S0341
S1015
S1016
RP0008 Bundled Services and Supplies Section 1 Code List
Page 3 of 5
UniCare Bundled Services and Supplies Section 1 Coding 02/07/2017
This table is provided as an informational tool only to help identify some examples of the services and
supplies described in Policy Section 1 of the Bundled Services and Supplies reimbursement policy. The
exclusion of a specific code does not indicate eligibility for reimbursement under all circumstances.
S1030
S2900
S3000
S3005
S3600
S3601
S3652
S3708
S3902
S3904
S4005
S4011
S4013-S4018
S4022
S4025
S4027
S4028
S4035
S4037
S4031
S4040
S4042
S5000
S5001
S8096
S8097
S8100
S8101
S5185
S8110
S8262
S8301
S8415
S9007
S9083
S9098
S9110
S9208
S9438
S9480
S9484
RP0008 Bundled Services and Supplies Section 1 Code List
Page 4 of 5
UniCare Bundled Services and Supplies Section 1 Coding 02/07/2017
This table is provided as an informational tool only to help identify some examples of the services and
supplies described in Policy Section 1 of the Bundled Services and Supplies reimbursement policy. The
exclusion of a specific code does not indicate eligibility for reimbursement under all circumstances.
S9485
S9900
S9901
S9992
S9996
S9999
T1040
T1041
T2022
RP0008 Bundled Services and Supplies Section 1 Code List
Page 5 of 5