CurrentFlorida BluePolicy 10-004

CMS MPFS B-Status (Bundled) Codes Payment Policy

Governs Florida Blue's reimbursement stance for HCPCS/CPT codes designated by CMS as B-status (bundled) on the Medicare Physician Fee Schedule; applies to billing on CMS-1500 or equivalent claim forms and affects all providers and lines of business rendering services to Florida Blue members.

Policy Summary

PayerFlorida Blue

PolicyCMS MPFS B-Status (Bundled) Codes Payment Policy

Policy CodePolicy 10-004

Change TypeNo material change

Effective DateDec 22, 2009

Next Review Date

Key ActionThis payment policy is not an authorization or guarantee of payment; benefits are determined by the group contract and member benefit booklet.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

B-statusCMS status applied to bundled codes

99050,99051Exempt CPT/HCPCS codes

99000,99001COVID-19 temporary exemptions

Modifiers 59/X*Modifier overrides denied

CMS-1500Billing form applicability

B-Status Reimbursement Criteria

B-status reimbursement criteria

Covered when ALL of the following are met:

Florida Blue will not separately reimburse CPT/HCPCS codes that CMS designates with MPFS status 'B' (bundled codes).

EXCEPT (covered separately)

Code 99050 is exempt from B-status nonpayment and may be reimbursed separately where applicable.
Code 99051 is exempt from B-status nonpayment and may be reimbursed separately where applicable.
Codes 99000 and 99001 were exempt for dates of service from 2020-03-17 through 2023-05-12 when obtained solely for COVID-19 sample collection and no other service was performed.

Policy Summary

PayerFlorida Blue

PolicyCMS MPFS B-Status (Bundled) Codes Payment Policy

Policy CodePolicy 10-004

Change TypeNo material change

Effective DateDec 22, 2009

Next Review Date

Key ActionThis payment policy is not an authorization or guarantee of payment; benefits are determined by the group contract and member benefit booklet.

SourceLink

On This Page

Exempted Codes and Date-based Exceptions

Exempted B-status codesCPTCovered

99050	Exempt from B-status nonpayment (listed by policy)
99051	Exempt from B-status nonpayment (listed by policy)
99000	Exempt for dates of service March 17, 2020 to May 12, 2023 when obtained for COVID-19 sample and no other service performed
99001	Exempt for dates of service March 17, 2020 to May 12, 2023 when obtained for COVID-19 sample and no other service performed

COVID-19 exemption date range

COVID-19 exemption date range03/17/2020 to 05/12/2023 — codes 99000 and 99001 exempt when obtained for COVID-19 sample collection and no other service was performed

Permanent exemptionsCodes 99050 and 99051 are exempt from B-status nonpayment and may be reimbursed separately

ScopeExemption for 99000/99001 applies only to dates of service within the specified range and only when the code was used solely for COVID-19 sample collection

Billing Applicability and Provider Notice

Note

Non‑authorization disclaimer and applicability

THIS PAYMENT POLICY IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT. Benefits are determined by the group contract, member benefit booklet, and/or individual subscriber certificate in effect at the time services were rendered. This policy applies to all lines of business and providers of service and applies to billing on a CMS-1500 or equivalent claim form.

Does not substitute for medical advice; medical decisions remain the responsibility of the patient and physician.
Legislative mandates, provider contract documents, or the member's benefit coverage may supersede this policy.
‘Same provider’ is defined as physicians and/or other health care professionals reporting under the same Federal Tax Identification Number for purposes of this policy.

Key Definitions

B (Bundled) status definition

DefinitionB (Bundled) status: Payment for covered services are bundled into payment for other services; there will be no RVUs or separate payment amount for these codes

Reimbursement ruleFlorida Blue will not separately reimburse HCPCS/CPT codes designated by CMS MPFS with status 'B' — they are considered bundled with other procedure codes

Modifier overrideModifiers 59, XE, XS, XP, or XU cannot be used to override B-status edits; claims with these modifiers on B-status codes will be denied for separate payment

Billing form applicabilityThis policy applies to billing on a CMS-1500 or equivalent claim form

Same provider definition

DefinitionSame provider: includes all physicians and/or other health care professionals reporting under the same Federal Tax Identification Number for purposes of this policy

PurposeUsed to determine when services are considered rendered by the same provider for B-status bundling and reimbursement decisions

Claiming implicationServices reported under the same Federal Tax Identification Number are treated as from the same provider and subject to bundling rules (no separate payment for B-status codes)