CurrentArizona Complete HealthPolicy CC.PP.046

Status 'B' Bundled Services

Defines payment rules for procedure codes designated by CMS with a status indicator of 'B' (always bundled) for all product types administered by Arizona Complete Health; applies to physician/non-physician practitioner services and outpatient institutional claims.

Policy Summary

PayerArizona Complete Health

PolicyStatus 'B' Bundled Services

Policy CodePolicy CC.PP.046

Change TypeAdministrative/code list updates

Effective DateJan 1, 2014

Next Review Date

Key ActionEnsure adjudication logic denies status 'B' lines when billed with non-'B' codes on the same claim and allows payment when billed alone or only with other status 'B' codes.

SourceLink

POLICY UPDATE CHANGES

03/10/2018 review removed duplicate codes and removed deleted codes 99363 and 99364.

11/23/2016 draft revised to include HCPCS codes and title change.

2014-01-01policy effective date

ALLproduct applicability

Physician/Non-physician/Outpatientapplication areas

Bundling decision logic

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ALL of the following

Claim lines are reviewed for same member, same provider ID, and same date of service.
If a procedure code on the claim is designated by CMS with status indicator 'B', check for other procedure(s) on the claim that are not designated 'B'.
If another procedure(s) is found that is not designated 'B', the service line with the status 'B' code is denied (payment subsumed by the other non-'B' service).
If a status 'B' code is billed alone, it is payable.
If a status 'B' code is billed with another procedure code that also has status 'B', the status 'B' codes will pay.

Referenced codes and code groups

Sample HCPCS/CPT/Local codes referenced in policy (Status 'B' examples and other referenced codes)mixed

A4262	Temporary tear duct plug
A4263	Permanent tear duct plug
A4270	Disposable endoscope sheath
A4300	Implantable access catheter
A4550	Surgical stockings below knee length, each
G0269	Occlusive device in vein art
G0501	Resource-intense service during ov
Q3031	Collagen skin test
R0076	Transport portable EKG
15850	Remove sutures same surgeon

1–10 of 86

1/9

What providers must do

Billing Rule

Claim submission and adjudication

Adjudication software will evaluate claims for same member, same provider ID and same date of service; deny status 'B' lines when billed with non-'B' codes on same claim (status 'B' lines pay when billed alone or only with other status 'B' codes).

Documentation Required

Documentation requirements

No additional documentation requirements specified in this policy.

Policy background and scope

Scope: This policy defines payment rules for procedure codes that the Centers for Medicare and Medicaid Services (CMS) designates with a status indicator of 'B' (always bundled). It applies to Physician and Non-physician Practitioner services and Outpatient Institutional claims and is applicable to all product types administered by Arizona Complete Health. The purpose of the policy is to provide criteria used to determine when a CMS-designated Status 'B' code is subsumed into payment for another billed service and therefore not separately payable. (See CMS National Physician Fee Schedule Relative Value File for the official status indicator designations.)

Applicability and adjudication note: Claims are evaluated by the Health Plan's adjudication software for the same member, same provider ID, and same date of service. If a procedure code on the claim is designated by CMS with status indicator 'B' and is billed on the same claim with another procedure that is not designated 'B', the Status 'B' line will be denied because payment is subsumed by the other service. Status 'B' codes are payable when billed alone or when billed only with other Status 'B' codes. Providers should review Medicare National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) for Medicare members prior to applying this policy.

Administrative notes: This document is the property of Centene Corporation. For Medicaid members, state Medicaid coverage provisions take precedence where conflicts exist; refer to the applicable state Medicaid manual. The policy effective date is 01/01/2014 and the last review was 03/10/2018. Recent revisions were administrative/code list cleanups (removed duplicate and deleted codes) and the addition of HCPCS codes in prior drafts; these are not material changes to the bundling rule.

Defined terms

Definitions

Incidental ProcedureA procedure carried out at the same time as a more complex primary procedure that requires minimal additional provider resources and is considered not necessary to the performance of the primary procedure.

Bundled Service (Status 'B')Procedure codes designated by the CMS National Physician Fee Schedule Relative Value File with a status indicator of 'B'; CMS defines these codes as 'Payment for covered services is always bundled into payment for other services not specified.'

Health PlanFor this payment policy, 'Health Plan' means a health plan that has adopted this payment policy and that is operated or administered, in whole or in part, by Centene Management Company, LLC, or any affiliate.

Policy Summary

PayerArizona Complete Health

PolicyStatus 'B' Bundled Services

Policy CodePolicy CC.PP.046

Change TypeAdministrative/code list updates

Effective DateJan 1, 2014

Next Review Date

Key ActionEnsure adjudication logic denies status 'B' lines when billed with non-'B' codes on the same claim and allows payment when billed alone or only with other status 'B' codes.

SourceLink

On This Page

OpenPayer

Status 'B' Bundled Services

Bundling decision logic

Referenced codes and code groups

What providers must do

Policy background and scope

Defined terms

Policy update changes

Status 'B' Bundled Services

Bundling decision logic

Referenced codes and code groups

What providers must do

Policy background and scope

Defined terms

Policy update changes

Related policies and references