CurrentHumanaPolicy CP2024001

Status B Codes reimbursement

This policy governs Humana's reimbursement stance for CPT/HCPCS codes designated as Status B on the Medicare Physician Fee Schedule for Kentucky Medicaid professional services; it affects providers submitting claims to Humana for Kentucky Medicaid members.

Policy Summary

PayerHumana

PolicyStatus B Codes reimbursement

Policy CodePolicy CP2024001

Change TypeNo material change

Effective DateJun 1, 2024

Next Review Date

Key ActionDo not separately bill for Status B codes for Kentucky Medicaid professional services; CPT 90887 is an exception and is reimbursed.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

No separate paymentpayment stance

90887explicit exception

Professional onlyservice scope

Kentuckyapplicability

Reimbursement Criteria for Status B Codes

Status B reimbursement criteria

Covered when the following reimbursement rules and exceptions are met:

Humana does not separately reimburse charges for CPT or HCPCS codes assigned payment status indicator 'B' on the MPFS Relative Value File; reimbursement is considered included in other same-day charges.

Exception

CPT code 90887 is reimbursed despite being assigned a Status B payment indicator.

This reimbursement stance applies only to professional services.

Claims remain subject to medical necessity, reasonableness, and any applicable referral or authorization requirements; additional payment rules (for example, Humana Healthy Horizons in Kentucky out-of-network payment policy) may apply.

Policy Summary

PayerHumana

PolicyStatus B Codes reimbursement

Policy CodePolicy CP2024001

Change TypeNo material change

Effective DateJun 1, 2024

Next Review Date

Key ActionDo not separately bill for Status B codes for Kentucky Medicaid professional services; CPT 90887 is an exception and is reimbursed.

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.

Codes and Payment Rules

Status B codes / ExceptionCPTCovered

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

Status B payment rule — overview

Rule summaryCodes assigned payment status indicator 'B' on the MPFS are not separately reimbursed when the service is covered—payment is considered included in other same‑day charges.

Applies toKentucky Medicaid professional services (Humana policy scope)

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

Key Definitions

MPFS 'Status B' — definition and payment implication

DefinitionA Status B code is a CPT/HCPCS code assigned a payment status indicator of 'B' on the Medicare Physician Fee Schedule (MPFS) Relative Value File.

Payment implicationIf the service is covered, there is no separate payment for a Status B code (payment is considered included in other services).

ScopeThis reimbursement stance applies to professional services under Kentucky Medicaid per Humana's policy.

Medicare Physician Fee Schedule (MPFS) Relative Value File

What it isThe MPFS Relative Value File is a file published by CMS that includes payment status indicators, relative value units (RVUs), and conversion factors for physician services.

Common nameAlso commonly referred to as the relative value unit (RVU) table.

Relevance to Humana policyHumana follows the MPFS Relative Value File payment status indicators to determine which codes are designated Status B and the associated reimbursement stance.

CPT code 90887

CPT descriptorInterpretation 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.

Exception statusCPT 90887 is explicitly identified in the policy as an exception to the Status B non‑payment rule and is reimbursed despite Status B designation.

Code systemCPT (Current Procedural Terminology)

OpenPayer

Status B Codes reimbursement

Reimbursement Criteria for Status B Codes

Codes and Payment Rules

Claims, Authorization, and Billing Requirements

Key Definitions