Status Codes

Description

All codes published on the National Physician Fee Schedule (NPFS) by the Centers for Medicare and Medicaid Services (CMS) are assigned a status code. The status code indicates whether the code is separately payable if the service is covered.

Same group practice is defined as a physician and/or other qualified health care professional of the same specialty with the same Federal Tax ID number.

Policy

Blue Cross Blue Shield North Carolina (Blue Cross NC) will reimburse status indicator codes according to the criteria outlined in this policy.

Reimbursement Guidelines

Status “B” codes

Payment for these services is always included in payment for other services not specified, whether billed alone or with another service. Status B code edits are applied to professional and outpatient facility claims. Status B codes are bundled. Certain benefit allowances may apply.

Status “P” codes

Payment for these services is considered bundled/excluded which are incidental to other payable services when performed by the same provider or same group practice on the same date of service and are therefore not separately payable.

Status “T” codes

Status T codes bundle into services assigned a status indicator of A (Active) or R (Restricted Coverage) provided on the same date of service by the same group practice, for which payment is made. Modifier overrides will not prevent codes with a status indicator of T from bundling into other services.

Rationale

Status indicator codes will be reimbursed consistent with CMS and in accordance with correct coding guidelines.

Billing and Coding

Applicable codes are for reference only and may not be all inclusive. For further information on reimbursement guidelines, please see the Blue Cross NC web site at www.bcbsnc.com .

Status “P” code list is accessible using the PFS link within the References section.

Status "B"

Status "T"

Related policy

Bundling Guidelines

Evaluation and Management Services

OCE Edits

References

Healthcare Common Procedure Coding System

American Medical Association, Current Procedural Terminology (CPT® )

Centers for Disease Control and Prevention, International Classification of Diseases, 10th Revision

Centers for Medicare and Medicaid Services, Physician Fee Schedule (PFS) PFS Relative Value Files | CMS

History

4/30/2021 New policy developed. Blue Cross Blue Shield North Carolina (Blue Cross NC) will provide reimbursement for select status indicator codes according to the criteria outlined in this policy. Notification on 4/30/2021 for effective date 7/1/2021. (eel)

12/30/21 Routine policy review. Clarification added to status B codes “whether billed alone or with another service.” Medical Director approved. (eel)

1/21/22 99050 and 99051 removed from Status B list in Billing and Coding Section. Refer to related Evaluation and Management Services policy. (eel)

6/1/22 Policy language updated throughout. Status “P” added to Reimbursement Guidelines section. Medical Director approved. Notification on 3/31/2022 for effective date 6/1/2022. (eel)

12/31/2022 Routine policy review. Minor revisions only. (ckb)

1/19/2024 G2211 removed from Status B list in Billing and Coding Section. Refer to Bundling Guidelines policy. (tlc)

11/1/2024 Clarification to the definition of same group practice. No change to policy intent. (tlc)

Application

These reimbursement requirements apply to all commercial, Administrative Services Only (ASO), and Blue Card Inter-Plan Program Host members (other Plans members who seek care from the NC service area). This policy does not apply to Blue Cross NC members who seek care in other states.

This policy relates only to the services or supplies described herein. Please refer to the Member's Benefit Booklet for availability of benefits. Member's benefits may vary according to benefit design; therefore, member benefit language should be reviewed before applying the terms of this policy.