CurrentHumanaPolicy CP2024001

Status B Codes — Kentucky Medicaid

Defines Humana's Kentucky Medicaid payment stance for CPT/HCPCS codes assigned a Medicare MPFS payment status indicator of 'B' and explains when reimbursement is or is not provided for professional services.

Policy Summary

PayerHumana

PolicyStatus B Codes — Kentucky Medicaid

Policy CodePolicy CP2024001

Change TypeMinor (no material changes)

Effective DateJun 1, 2024

Next Review Date

Key ActionDo not separately bill for codes with MPFS status indicator 'B' for professional services unless specifically excepted (e.g., reimburse CPT 90887).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not reimbursedHumana stance for MPFS status B codes

90887Exception

ProfessionalService setting

KentuckyGeographic applicability

Coverage Criteria

Status B code reimbursement criteria

Humana's payment rule for Status B codes under Kentucky Medicaid for professional services:

Do not separately reimburse CPT/HCPCS codes assigned an MPFS payment status indicator of 'B'.

Exception

CPT code 90887: Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient.

Claims remain subject to other plan requirements such as medical necessity, reasonableness, and any applicable referral or authorization requirements; additional payment rules (e.g., out-of-network payment policy) may apply.

This policy applies only to professional services under Kentucky Medicaid.

Policy Summary

PayerHumana

PolicyStatus B Codes — Kentucky Medicaid

Policy CodePolicy CP2024001

Change TypeMinor (no material changes)

Effective DateJun 1, 2024

Next Review Date

Key ActionDo not separately bill for codes with MPFS status indicator 'B' for professional services unless specifically excepted (e.g., reimburse CPT 90887).

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.

Coding and Payment Rules

Exception to Status B nonpaymentCPTCovered

90887

Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient

Payment rule for Status B codes

Payment ruleHumana does not separately reimburse CPT/HCPCS codes assigned a payment status indicator of 'B' on the MPFS Relative Value File; reimbursement is considered included in any other same‑day charge.

ScopeThis payment rule applies only to professional services under Kentucky Medicaid.

ExceptionHumana reimburses CPT code 90887 despite its status B designation.

Related payment rulesAdditional payment rules may apply (for example, Humana Healthy Horizons in Kentucky out‑of‑network payment policy) where applicable.

Claims requirementsClaims remain subject to medical necessity, reasonableness, and any applicable referral or authorization requirements.

Provider Authorization and Claim Requirements

Documentation Required

Authorization and claim requirements

Claims are subject to other plan requirements for processing and payment, including medical necessity, reasonableness, and any applicable referral or authorization requirements; providers should consult Humana resources (for example, Availity) for claim and authorization processing details.

Humana considers additional payment rules may apply (e.g., out-of-network payment policy for Humana Healthy Horizons in Kentucky).
Providers can use Availity to access information on eligibility, benefits, referrals, authorizations, and claims.

Definitions

Status B code — definition

DefinitionA code with a payment status indicator of 'B' on the Medicare Physician Fee Schedule (MPFS) Relative Value File; if the service is covered, there is no payment.

ImplicationHumana treats reimbursement for Status B codes as included in reimbursement for other same‑day charges (i.e., no separate payment).

Policy exceptionIndividual Status B codes may be reimbursed if specifically excepted by policy (e.g., CPT 90887).

Medicare Physician Fee Schedule (MPFS) Relative Value File

What it isA file published by the Centers for Medicare & Medicaid Services that includes payment status indicators, relative value units and conversion factors for physician services (commonly called the RVU table).

Usage in policyHumana adopts the MPFS Relative Value File payment status indicator to determine when codes are not separately reimbursed (status 'B').

ContentsIncludes, among other information, payment status indicator, relative value units and conversion factors used for physician service payment determinations.

CPT code 90887 — description

CodeCPT 90887

DescriptionInterpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient.

Policy relevanceAlthough listed as a status B code on the MPFS Relative Value File, Humana specifically reimburses CPT 90887 under this policy.