CurrentUnitedHealthcarePolicy N/A

CMS NPFS status code 'B' (B Bundle) reimbursement policy

Defines UnitedHealthcare Community Plan's reimbursement stance for CPT/HCPCS codes assigned status code 'B' on the CMS National Physician Fee Schedule Relative Value File; applies to providers billing on CMS-1500/UB04 where specified and to UnitedHealthcare Community Plan Medicaid products.

Policy Summary

PayerUnitedHealthcare

PolicyCMS NPFS status code 'B' (B Bundle) reimbursement policy

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionDo not submit prior authorization to obtain separate reimbursement for NPFS status code 'B' services; these codes are not separately payable and modifiers do not change that.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not reimbursablepolicy stance

CMS-1500forms covered

Listedstate exceptions

No effectmodifier rule

Coverage Criteria

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Primary coverage rules

Covered when ALL of the following are met:

Codes assigned status code 'B' on the NPFS Relative Value File are not separately reimbursable by UnitedHealthcare Community Plan regardless of whether they are billed alone or in conjunction with other services.

Payment for covered services assigned status code 'B' is bundled into payment for other services; RVUs shown for these codes are not used for Medicare payment and UnitedHealthcare does not use them to reimburse separately.

Appending modifiers does not make a B Bundle code reimbursable; modifiers do not change the non‑reimbursable status of B Bundle codes.

State exceptions and overrides

State-specific exceptions and overrides (examples shown; providers must consult state attachments for full lists):

Examples of state exceptions

Colorado: Codes 90887, 99366, 99367, and 99368 are exempt from this policy.
Idaho: Code 90889 is exempt from this policy.
North Carolina: Codes 99100, 99116, 99135, 99140, 99367 and 99368 are exempt from this policy.
Texas: Codes 99366, 99367, 99100, 99116, 99135, and 99140 are listed as exempt in the state section.
Tennessee: Code 99071 is exempt from this policy.
Washington: Codes 99366, 99368 and 92352 are exempt for Behavioral Health providers.
Virginia: Per state regulations, CPT codes 99100, 99116, 99135 and 99140 are allowed.

Providers must consult the state‑specific attachments or the state sections referenced in this policy for the complete and authoritative list of exempted codes per state.

State exemptions override the general non‑reimbursement stance for the specific codes and states listed; applicability is limited to the named state programs as documented.

Coding and Code Lists

Listed B bundle CPT/HCPCS codes (partial)mixedNot Covered

90885	Example code listed in B Bundle Codes listing
92352	Example bundled code mapping present in listing
99080	Listed among B bundle codes

North Carolina exemptions

Exempted CPT codes in North CarolinaCodes 99100, 99116, 99135, 99140, 99367 and 99368 are exempt from the B bundle restriction in North Carolina.

Scope of exemptionExemption applies to UnitedHealthcare Community Plan reimbursement policy for codes assigned status code 'B' on the NPFS Relative Value File when billing under North Carolina rules.

Action for providers in NCProviders in North Carolina should reference the state-specific exemption list when billing these codes to determine separate reimbursement eligibility.

Provider Actions and Billing Guidance

Billing Rule

Do not request PA for B Bundle codes; modifiers do not change reimbursement

Do not submit prior authorization requests seeking separate reimbursement for codes assigned NPFS status code 'B'. UnitedHealthcare Community Plan will not separately reimburse B Bundle codes whether billed alone or with other services, and appending modifiers does not make them payable.

B Bundle codes are not reimbursable services regardless of whether they are billed alone or in conjunction with other services.
Appending modifiers does not make a B Bundle code reimbursable.

Documentation Required

Consult state-specific exception lists for exempted codes

Check the state-specific exceptions listed in the policy attachments and state sections for codes that are exempt from the B bundle restriction before billing or seeking reimbursement.

Examples: Colorado exempts 90887, 99366, 99367, 99368; North Carolina exempts 99100, 99116, 99135, 99140, 99367, 99368; Texas and other states have listed exemptions — consult the full state lists/attachments.
Providers must consult the attachments or the state-specific sections referenced in this policy for the complete list of exempted codes per state.

Definitions

Status code 'B' (Bundled service) — payment guidance

DefinitionStatus code 'B' (Bundled service): Payment for covered services are bundled into payment for other services; if covered, payment is subsumed by payment for incident services and RVUs shown are not used for Medicare payment.

UnitedHealthcare payment stanceUnitedHealthcare Community Plan will not separately reimburse CPT/HCPCS codes assigned status code 'B' on the NPFS Relative Value File; B Bundle Codes are not reimbursable whether billed alone or with other services.

Modifier ruleAppending modifiers does not make a B Bundle code reimbursable; modifiers do not change the bundled payment status.