Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided); each supply or material provided
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Supplies/materials not separately billable - bundled into procedure
Very Common99070 (supplies/materials provided by physician over and above usually included in procedure/E&M) is for EXTRAORDINARY supplies, not routine supplies bundled into procedure codes. Denied when supplies are standard part of procedure (e.g., suture material for laceration repair already included in repair code). Use only for unusual/exceptional supplies beyond typical.
Common Causes
- • Billed 99070 for suture material during laceration repair - that's included in 12001 code
- • Billed for standard bandages, gauze, tape - included in E&M/procedure codes
- • Used for prescription medications - should use J-codes or drug codes instead
Resolution Strategy
Verify supplies are truly extraordinary, not routine. Examples of potentially separately billable supplies: Custom orthotic device provided and fitted, specialized burn dressings beyond standard wound care, specialized supplies not typically stocked. Document: 'Applied silver-impregnated hydrofiber dressing (Aquacel Ag) 10x10cm to burn wound, patient given additional dressing for home use, retail cost $85.' Most routine supplies (bandages, gauze, exam gloves, tongue depressors, standard sutures) are NOT separately billable - bundled into E&M and procedure codes. If supplies routine, cannot appeal - not separately payable.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For supplies and materials provided by physician/provider beyond those included in standard office visit, including splints, casts, special dressings
Common Scenarios
Documentation Requirements
- Specific supply or material provided
- Quantity provided
- Cost basis if tracking for billing
- Medical necessity for supply
Coding Guidelines
Common Modifiers
Bundling Rules
- Usually bundled into procedure code
- Separate only if unusual or high-cost
- Patient may be charged separately
Exclusions
- Spectacles/glasses cannot be billed
- Items included in regular office visit
- Standard supplies typically included
Coding Notes
Clinical scenarios
- Specific supply or material provided
- Quantity provided
- Cost basis if tracking for billing
- Specific supply or material provided
- Quantity provided
- Cost basis if tracking for billing
- Specific supply or material provided
- Quantity provided
- Cost basis if tracking for billing
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Ask a QuestionFrequently Asked Questions
CPT 99070 is the billing code for "Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided); each supply or material provided". For supplies and materials provided by physician/provider beyond those included in standard office visit, including splints, casts, special dressings
The most common denial reason for CPT 99070 is "Supplies/materials not separately billable - bundled into procedure". 99070 (supplies/materials provided by physician over and above usually included in procedure/E&M) is for EXTRAORDINARY supplies, not routine supplies bundled into procedure codes. Denied when supplies are standard part of procedure (e.g., suture material for laceration repair already included in repair code). Use only for unusual/exceptional supplies beyond typical. Common causes include: Billed 99070 for suture material during laceration repair - that's included in 12001 code; Billed for standard bandages, gauze, tape - included in E&M/procedure codes. Appeal success rate is approximately 10-30%.
Key documentation requirements for CPT 99070 include: Specific supply or material provided; Quantity provided; Cost basis if tracking for billing; Medical necessity for supply. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 99070: Usually bundled into procedure code. Separate only if unusual or high-cost Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 99070 include: 59 (Distinct supply if clearly separated). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 99070 is Not applicable - supply code. Time-based codes require documentation of the actual time spent providing the service.