CurrentFlorida BluePolicy 10-022

T-Status Codes

Governs reimbursement of procedure codes with a CMS 'T' status on CMS-1500 or equivalent claim forms; applies to all providers and lines of business. Same-provider determination is by Federal Tax Identification number.

Policy Summary

PayerFlorida Blue

PolicyT-Status Codes

Policy CodePolicy 10-022

Change TypeNo material change

Effective DateOct 1, 2014

Next Review Date

Key ActionDo not submit appeals or expect modifier overrides; T-status codes are bundled and not separately reimbursed when another physician-fee-schedule service is paid the same date by the same provider.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

No separate paymentBundling when paid same day

Not acceptedModifier overrides

Not acceptedAppeals

CMS-1500Form applicability

36591, 94760, G0117Example codes

Reimbursement Rules for 'T' Status Codes

T-status reimbursement criteria

Reimbursement rules for CMS 'T' status codes when billed to Florida Blue:

T-status codes have RVUs and payment amounts but are paid only if there are no other services payable under the physician fee schedule billed on the same date by the same provider.

If any other physician-fee-schedule payable service is billed on the same date by the same provider, T-status codes are bundled into the paid service and not separately reimbursed.

Same-provider determination: includes all physicians and other health care professionals reporting under the same Federal Tax Identification number.

No modifier overrides will exempt T-status codes from bundling into services for which payment is made.

Policy Summary

PayerFlorida Blue

PolicyT-Status Codes

Policy CodePolicy 10-022

Change TypeNo material change

Effective DateOct 1, 2014

Next Review Date

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Example T-Status Procedure Codes

Example T-status procedure codesCPT | HCPCS

36591	Collection of blood specimen from a completely implantable venous access device.
36592	Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified.
36598	Contrast injection(s) for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report.
94760	Noninvasive ear or pulse oximetry for oxygen saturation; single determination.
94761	Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (e.g., during exercise).
96523	Irrigation of implanted venous access device for drug delivery systems.
G0117	Glaucoma screening for high-risk patients furnished by an optometrist or ophthalmologist.
G0118	Glaucoma screening for high-risk patients furnished under the direct supervision of an optometrist or ophthalmologist.

Overrides, Appeals, and Provider Instructions

Denial Risk

No prior auth or appeals to override T‑status bundling

No prior authorization or appeals will be accepted to override bundling of T‑status codes. This policy applies to services billed on a CMS‑1500 or equivalent claim form and to all providers reporting under the same Federal Tax Identification number; failure to comply may result in denial of separate payment for T‑status codes when another physician‑fee‑schedule service is paid on the same date by the same provider.

No modifier overrides will exempt T‑status codes from bundling.
Appeals to override this policy will not be accepted.

Key Definitions

Same provider — determination

DefinitionSame provider = all physicians and/or other health care professionals reporting under the same Federal Tax Identification number.

ScopeUsed to determine bundling of CMS 'T' status procedure codes when services are billed the same date.

Applies toServices billed on a CMS-1500 or equivalent claim form and to all lines of business and providers of service.

T-status codes — CMS 'T' status explanation

Basic definitionCMS 'T' status codes have RVUs and payment amounts but are paid only if there are no other physician-fee-schedule payable services billed the same date by the same provider.

Bundling ruleIf any other physician-fee-schedule payable service is billed on the same date by the same provider, T-status codes are bundled into the paid service and not separately reimbursed.

Modifiers and overridesNo modifier overrides will exempt T-status codes from bundling into services for which payment is made.

AppealsAppeals to override this policy will not be accepted.