CurrentUnitedHealthcarePolicy 2026R0100B

B Bundle Codes reimbursement

Defines UnitedHealthcare's reimbursement stance for CPT/HCPCS codes assigned status code 'B' on the CMS NPFS Relative Value File and applies to services billed on CMS-1500 (and electronic equivalent) for UnitedHealthcare Commercial and most Individual Exchange plans.

Policy Summary

PayerUnitedHealthcare

PolicyB Bundle Codes reimbursement

Policy CodePolicy 2026R0100B

Change TypeRevised (B Bundle Codes list updated)

Effective Date

Next Review Date

Key ActionDo not bill expecting separate reimbursement for codes assigned status code 'B'; appending modifiers does not change nonreimbursable status.

SourceLink

POLICY UPDATE CHANGES

Updated the B Bundle Codes List.

Policy applies to all UnitedHealthcare Commercial benefit plans and Individual Exchange plans in all states except Mississippi.

CMS-1500Claim form applicability

CommercialPlan applicability

Exchange (excl. MS)Exchange applicability

B = bundledCoverage stance

Modifiers do not enable payment

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Coverage Criteria

B Bundle Codes coverage criteria

Coverage stance for B Bundle Codes

Codes assigned status code 'B' on the NPFS Relative Value File are considered bundled and are not separately reimbursable by UnitedHealthcare.

B Bundle Codes are not reimbursable whether billed alone or with other services.

Appending a modifier does not make a B Bundle Code reimbursable.

Coding and Reimbursement Details

B Bundle Codes (examples)mixedNot Covered

90885	Example listed among B Bundle Codes
90887	Mapped/paired in list
90889	Mapped/paired in list
92352	Example listed among B Bundle Codes
92353	Example listed among B Bundle Codes
92354	Example listed among B Bundle Codes
92355	Example listed among B Bundle Codes
92358	Example listed among B Bundle Codes
92371	Example listed among B Bundle Codes
92531	Mapped/paired in list

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Reimbursement threshold

Reimbursement ruleCodes assigned status code 'B' are bundled and not separately payable regardless of billing context.

Billing contextNot payable whether billed alone or with other services.

Modifier effectAppending a modifier does not convert a status code 'B' code into a payable service.

Applicable code setsApplies to CPT and HCPCS codes listed on the NPFS Relative Value File with status code 'B'.

Provider Actions and Billing Rules

Billing Rule

Do not bill B Bundle Codes for separate reimbursement; modifiers do not enable payment

Consistent with CMS NPFS guidance, UnitedHealthcare will not separately reimburse CPT or HCPCS codes assigned status code 'B' on the NPFS Relative Value File; these codes are considered bundled and not payable, and appending modifiers does not change their nonreimbursable status.

Status code 'B' services are bundled into payment for other services and are not separately payable.
B Bundle Codes are not reimbursable whether billed alone or with other services.
Appending a modifier does not make a B Bundle Code reimbursable.

Definitions

Status code 'B' (NPFS Relative Value File)

DefinitionStatus code 'B' is a designation on the CMS NPFS Relative Value File indicating the service is bundled into payment for other services and not separately payable.

CMS description"Payment for covered services are always bundled into payment for other services not specified...If these services are covered, payment for them is subsumed by the payment for the services to which they are incident." (NPFS public use file)

UnitedHealthcare applicationUnitedHealthcare follows CMS guidance and will not separately reimburse codes assigned status code 'B'.

CMS-1500 (1500 Health Insurance Claim Form)

Form nameCMS-1500 (1500 Health Insurance Claim Form)

Applicability