Description
This policy addresses reimbursement for Status Indicator B codes.
Definition
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Status Indicator B Codes
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A code classification data element found on the National Physician Fee Schedule (NPFS), as maintained by The Center for Medicare & Medicaid Services (CMS). This data element indicates a code that is always bundled into payment for other services.
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Policy
Blue Cross Blue Shield of North Dakota (BCBSND) uses the CMS NPFS Resource Based Relative Value Scale (RBRVS) to identify those procedure codes identified with status indicator of “B”. Status B codes are not eligible for reimbursement, whether billed alone or with other services as these codes are considered an integral part of another service.
Note: BCBSND updates codes quarterly when made available by The CMS and the American Medical Association (AMA). The official update of the Healthcare Common Procedure Coding System (HCPCS) for public use is located at https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update
The official update of the AMA is located at https://www.ama-assn.org/.
Limitations and Exclusions
While reimbursement is considered, payment determination is subject to, but not limited to:
- Group or Individual benefit
- Provider Participation Agreement
- Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, payment integrity edits and medical necessity
- Mandated or legislative required criteria will always supersede.
In instances where the provider is participating, based on member benefits, co-payment, coinsurance, and/or deductible shall apply.
Cross Reference
CMS PFS Relative Value Files
History
Date
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Updates
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01/05/2021
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Created policy for Status B codes. This information is also noted in the Professional Reimbursement Notice.
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4/25/2021
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Added a note that codes are updated quarterly.
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4/28/2022
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Updated formatting.
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8/23/2023
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Policy annual review completed.
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