Professional Services Claims
Coding Policy
Title
Medicare Indicator ‘Status B’ Services Reimbursement
Number
Last Approval
Date
Replaces
Cross
Reference
CP.PP.366.v1.9
08/08/16
Original
Effective Date
11/17/08
N/A
Coverage of any service is determined by a member’s eligibility, benefit limits for the service or services rendered and the
application of the Plan’s Medical Policy. Final payment is subject to the application of claims adjudication edits common to the
industry and the Plan’s payment policies. Reimbursement is restricted to the provider's scope of practice as well as the fee schedule
applicable to that provider
Purpose
Scope
Definitions
Policy
To define how the Plan handles services designated on the National Physician Fee
Schedule (NPFS) Relative Value file with a Status B indicator, for medical and surgical
services and supplies.
Applies to all Company lines of business and products with the exception of Medicare
Advantage.
Status Indicator B codes: A code classification data element found on the NPFS, as
maintained by the Center for Medicare and Medicaid Services (CMS). This data
element indicates a code that is always bundled into payment for other services.
Procedure codes identified with an NPFS Status indicator of B are not eligible for
reimbursement, whether billed alone or with another service, and will be denied. These
codes are considered an integral part of another service.
The Plan’s payment policy is based upon the most current published list or update of
Status B designations from CMS in the NPFS.
Note: The CMS assigns status indicators to procedure codes to show whether the code
is included in the physician fee schedule or whether the code is separately payable if the
service is covered.
An NPFS Status indicator of B describes a bundled code. Reimbursement for these
services is included in the reimbursement for another service, whether billed on the
same date of service as the primary code or billed alone and on a different date of
service.
To obtain a complete current list of Status B codes, visit the CMS web site using the
following link and select the most current NPFS Relative Value File release:
http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/PhysicianFeeSched/PFS-Relative-Value-Files.html
Violations of
Policy
Violations of this policy by any party that enters into a written arrangement with the
Plan may result in increased auditing and monitoring, performance guarantee
contractual penalties and/or termination of the contract. Disciplinary actions will be
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This policy was published on August 10, 2016
© 2016 PREMERA. All Rights Reserved.
appropriate to the seriousness of the violation and shall be determined in Plan’s sole
discretion.
Violations of this policy may be grounds for corrective action, up to and including
termination of employment.
Exceptions
Laws,
Regulations &
Standards
References
None
Washington Senate Bill 5346 -
Policy Owner
Review
Contact
Provider Billing Integrity Oversight Committee
Annual Review
Dates
08/08/16; 08/10/15; 08/10/14; 01/12/14; 01/13/13; 01/26/12; 01/27/11; 03/04/10;
10/09/09



Center for Medicare and Medicaid Services (CMS)
National Physician Fee Schedule (NPFS) Relative Value File
Washington Senate Bill 5346
Any questions regarding the contents of this policy or its application should be directed
to the HCDS Compliance and Payment Policy Department.
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