FAQs
Services Reimbursement for “Status B” Indicator
Policy Change Effective October 1, 2015
Overview: The Centers for Medicare and Medicaid Service (CMS) assigns status indicators to procedure
codes to show whether the code is included in the National Physician Fee Schedule (NFFS) or whether the
code is separately payable if the service is covered. According to CMS, a NPFS status indicator of ‘B’
describes a “bundled code” and reimbursement for these services is always included in the reimbursement for
another service.
Effective October 1, 2015, Blue Cross and Blue Shield of North Carolina (BCBSNC) will follow CMS guidelines
and will not separately reimburse certain procedures identified as "B" status codes on the NPFS, whether billed
on the same date of service as the primary code or billed alone and on a different date of service.
What is a status “B” indicator?
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” meaning payment for covered services are always bundled into payment for other
services not specified. There are no RVUs or payment amount for these codes and no separate payment is
allowed. When these services are covered, payment for them is subsumed by the payment for the services to
which they are incident (an example is a telephone call from a hospital nurse regarding care of a patient).
Why is BCBSNC revising the reimbursement policy for “B” status codes?
BCBSNC continues our efforts to offer affordable health care in North Carolina. We have revised our policy to
better bring BCBSNC’s reimbursement in line with that of CMS and industry standards.
Is this policy change applicable to all BCBSNC lines of business?
The policy change does not impact BCBSNC Medicare Advantage plans (Blue Medicare HMOSM and Blue
Medicare PPOSM) and the Federal Employee Program.
What happens if a provider uses modifier -59 in place of the “B” status code?
BCBSNC reserves the right to review claims for inappropriate coding. Use of the modifier -59 to override “B”
status code edits is not eligible for reimbursement and is subject to BCBSNC’s claim review process.
Where can providers obtain a list of status “B” codes?
To obtain a complete list of status “B” codes, providers can visit the CMS website, www.cms.gov. Always
select the most current NPFS Relative Value File release.
If a code with status indicator of “B” is billed for a member, whose liability is the denied service?
Providers are held liable when the denied service is due to a code(s) being submitted with the status “B”
indicator. BCBSNC members will be held harmless.
Are there any exceptions to the policy?
There are no exceptions to the policy. For claims filed on or after October 1, 2015, BCBSNC will follow CMS
guidelines and will not separately reimburse certain procedures identified as "B" status codes on the NPFS,
whether billed on the same date of service as the primary code or billed alone and on a different date of
service.
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What happens if a provider violates the policy?
BCBSNC participating providers are responsible for accurate submission of claims. BCBSNC reserves the
right to conduct claim audits to ensure compliance with our billing guidelines. Violation of this policy or any
BCBSNC policy may be grounds for disciplinary action including but not limited to the right to recoup money
paid when an audit reveals patterns of inappropriate billing. Additionally, violations of BCBSNC policies may
be grounds for termination of your provider/facility contractual agreement with BCBSNC.
Where can providers obtain additional information regarding BCBSNC medical policies and claim filing
guidelines?
BCBSNC’s Corporate Reimbursement Policy, Code Bundling Rules Not Addressed in ClaimCheck® or Correct
Coding Initiative and the BlueBookSM Provider eManual are resources that offer additional information
regarding BCBSNC’s policies and claim filing guidelines.
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