October 5, 2017
What is a Medicare Status B Code? The Center for Medicare and Medicaid Services (CMS) maintains the National Physician Fee Schedule (NPFS) which contains CPT and HCPCS procedure codes. Each of these codes has a Status Indicator flag. This flag classifies the code into a specific category indicating how it will be handled in claims processing and whether it will be reimbursed.
Some examples of Status Indicator flags include:
- Status A = Active Code
- Status B = Bundled Code
- Status D = Deleted Code
- Status M = Measurement code
- Status T = Injections
We use these classifications as part of our claims editing system. Status Indicator B indicates a service that's always bundled into another service. Reimbursement of this service is always included in the payment for another service, whether the code is billed on the same date of service as a primary code or billed alone on a different date or claim.
Like CMS, Premera doesn't reimburse these codes. When they are billed, the procedure code line will be denied with the following explanation code:
J84 - Unbundled procedure-Status B Code
To obtain a complete list of “Status B Codes” that are incorporated in the Claims Editor, link to the CMS website and select the most current version of the NPFS.
In addition, review the Medicare Indicator 'Status B' Services Reimbursement payment policy for further details.