Updates on Status "B" and "T" Codes for Reimbursement

Effective July 1, 2021, there will be updates to the Status "B" and Status "T" codes found in the National Physician Fee Schedule (NPFS) by the Centers for Medicare and Medicaid Services (CMS) that will impact reimbursement. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will update its list of Status "B" and Status "T" codes to align with CMS guidelines.  

All codes published on the NPFS by CMS are assigned a status code. The status code indicates whether the code is separately payable if the service is covered.  

Status “B” codes follow the guidelines below: 

• Payment for these services is always included in payment for other services not specified.  
  
• Status B code edits are applied to professional and outpatient facility claims.  
• Status B codes are bundled.  
• Certain benefit allowances may apply.  

Status “T” codes follow the guidelines below: 

• 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. 

These changes apply to the following lines of business: Administrative Services Only (ASO groups), Federal Employee Program (FEP), fully insured membership, Blue Card IPP Host, and the State Health Plan (SHP).