CurrentPremera BluecrossPolicy N/A

Medicare NPFS Status Indicator B, P, and T Services Reimbursement

Defines how Premera Blue Cross and affiliated plans manage reimbursement for procedure codes designated with CMS NPFS Status Indicators B, P, and T for professional claims (CMS-1500/837P). Applies to the listed Premera and LifeWise lines of business and their providers.

Policy Summary

PayerPremera Bluecross

PolicyMedicare NPFS Status Indicator B, P, and T Services Reimbursement

Policy CodePolicy N/A

Change TypeMaterial coding and reimbursement updates

Effective DateVaries by change (see details)

Next Review DateJan 8, 2025

Key ActionBill per CMS NPFS status: treat many Status P codes as bundled when incident to physician services and apply exceptions for DME suppliers and specific codes.

SourceLink

POLICY UPDATE CHANGES

Status Indicator P codes will be considered bundled and may no longer be separately reimbursable when submitted incident to other physician services effective with claim dates of service on and after October 6, 2024.

Code G2211 (visit complexity add-on) is considered bundled and not separately reimbursable effective October 6, 2024.

Procedure code 99072 reverted to Status Indicator B and is non-reimbursable for all providers effective July 8, 2023.

Code 96041 (genetic counseling by trained genetic counselors) effective January 1, 2025, is reimbursable when provided by trained genetic counselors per CPT guidelines; 96040 terminated December 31, 2024.

3Status indicators addressed (B, P, T)

Oct 6, 2024P codes bundled effective

Jul 8, 202399072 reverted

Jan 1, 202596041 effective

DME exemptionDME exemption

Coverage criteria and exceptions

Coverage criteria and exceptions for Status B/P/T codes

Reimbursement follows CMS NPFS Status Indicators B, P, and T; final payment depends on member eligibility, benefit limits, provider scope of practice, and claims edits.

The Plan uses the current CMS National Physician Fee Schedule (NPFS) Relative Value file applicable to the date of service to identify Status Indicator B, P, and T codes and determine reimbursement applicability.

Status B: Codes that are included/integral in the reimbursement for another service and are not eligible for separate reimbursement whether billed alone or with another service.

Status T: Codes that are not reimbursed when submitted with other payable services billed on the same date of service by the same provider for the same member; reimbursable only when billed alone by that provider for that member/date.

Status P: If the P-status item or service is incident to a physician service and provided on the same date, payment for the P code is bundled into the physician service; if provided without any physician service (not incident to), the P code may be reimbursable.

Policy Summary

PayerPremera Bluecross

PolicyMedicare NPFS Status Indicator B, P, and T Services Reimbursement

Policy CodePolicy N/A

Change TypeMaterial coding and reimbursement updates

Effective DateVaries by change (see details)

Next Review DateJan 8, 2025

Key ActionBill per CMS NPFS status: treat many Status P codes as bundled when incident to physician services and apply exceptions for DME suppliers and specific codes.

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.

Notable codes, status changes, and coding details

Notable codes and status changesCPT | HCPCS

99072	Additional supplies, materials, and clinical staff time during a Public Health Emergency; reverted to Status B and non-reimbursable effective July 8, 2023
G2211	Visit complexity add-on; considered bundled and not separately reimbursable effective October 6, 2024
96040	Medical genetics and genetic counseling services — terminated December 31, 2024
96041	Medical genetics and genetic counseling services by genetic counselor — effective January 1, 2025; reimbursable when performed by trained genetic counselors and meeting CPT time rules
V2520	Contact lens, hydrophilic, spherical, per lens — exempt from Status P policy and reimbursable

Minimum time for 96041

Minimum time thresholdDo not report CPT 96041 for less than 16 minutes of genetic counseling time

Effective date guidanceCPT 96041 effective January 1, 2025; reimbursable only when provided by trained genetic counselors per CPT guidelines

Related termination noteCPT 96040 terminated December 31, 2024 (replaced by 96041)

Billing and submission actions for providers

Billing Rule

Billing and submission actions for providers regarding Status B/P/T codes

Providers must follow CMS NPFS Status B, P, and T billing rules for services submitted on CMS 1500 or 837P claims. Review the applicable Status Indicator for the date of service — payment and bundling rules are determined by the current CMS NPFS Relative Value file. Use the CMS NPFS file release that corresponds to the claim date to confirm whether a code is designated B, P, or T.

Status B: Service is included/integral to another service and is not eligible for separate reimbursement whether billed alone or with another service.
Status P: Payment is bundled when the item/service is provided as "incident to" a physician service and is furnished on the same date; if provided without any other physician service or not incident to a physician service, the Status P code may be reimbursable.
Status T: Not reimbursed when submitted with other payable services billed by the same provider for the same member on the same date of service (same claim or multiple claims). Reimbursable only if billed alone and no other payable services are billed by the same provider for that member on that date of service.

Status indicator definitions

Status Indicator B

DefinitionStatus Indicator B: a code which is included/integral in the reimbursement for another service and is not eligible for separate reimbursement whether billed alone or with another service

Payment implicationNo separate payment is made for these services under the physician fee schedule when billed with the associated service

Source of designationStatus indicators are identified from the CMS NPFS Relative Value file applicable to the date of service

Status Indicator P

DefinitionStatus Indicator P: a code that is bundled/excluded when rendered on the same date as a physician service; no RVUs are assigned and no separate payment is made when billed on the same date as a physician service

Reimbursement conditionIf provided without any physician service (not incident to a physician service), the Status P code may be reimbursable

Policy changeEffective with claim dates of service on and after October 6, 2024, many Status P codes will be treated as bundled when incident to physician services

Status Indicator T

DefinitionStatus Indicator T: a code that is not reimbursed when submitted with other payable services billed on the same date of service by the same provider; reimbursable only if billed alone for that provider/member/date

Billing conditionNot reimbursed whether billed on the same claim or multiple claims for the same member/date when other payable services are present

Reimbursement conditionWhen billed alone (no other payable services by that provider for that member/date), the Status T code is reimbursable