CurrentUnitedHealthcarePolicy N/A

NPFS status indicator T bundling/reimbursement

Defines UnitedHealthcare Community Plan Medicaid reimbursement treatment for CPT/HCPCS codes with National Physician Fee Schedule (NPFS) status indicators (particularly T), including bundling rules when multiple services are reported on the same date by the same provider.

Policy Summary

PayerUnitedHealthcare

PolicyNPFS status indicator T bundling/reimbursement

Policy CodePolicy N/A

Change TypeAdministrative/history update

Effective DateN/A

Next Review DateN/A

Key ActionSubmit accurate claims using CPT/HCPCS per CMS/NPFS guidelines; follow CMS-1500 form or electronic equivalent.

SourceLink

POLICY UPDATE CHANGES

History entries updated with Annual Policy Version Change History dates including 5/19/2025 and prior archival notes.

status indicator Tcodes considered bundled into payable services when billed same date by same provider

status indicator Acodes that are separately payable under physician fee schedule if covered

status indicator Rrestricted coverage; carrier priced if covered

CMS NPFSsource of status indicators and RVU assignments

NPFS-Based Reimbursement and Bundling Rules

Policy Summary

PayerUnitedHealthcare

PolicyNPFS status indicator T bundling/reimbursement

Policy CodePolicy N/A

Change TypeAdministrative/history update

Effective DateN/A

Next Review DateN/A

Key ActionSubmit accurate claims using CPT/HCPCS per CMS/NPFS guidelines; follow CMS-1500 form or electronic equivalent.

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.

NPFS-based payment criteria

Payment and bundling rules for codes assigned National Physician Fee Schedule (NPFS) status indicators when billed to UnitedHealthcare Community Plan Medicaid.

UnitedHealthcare follows NPFS status indicators to determine payment and bundling for services billed under the physician fee schedule.

ALL of the following

Codes with status indicator T have RVUs and payment amounts but are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider; if any other payable physician fee schedule service is billed on the same date by the same provider, the T-coded services are bundled into the payable service.
UnitedHealthcare considers CPT/HCPCS codes with status indicator T bundled into any other service provided on the same date by the Same Individual Physician or Other Qualified Health Care Professional for which payment is made; no modifier overrides will exempt a T code from bundling.

Exceptions / payable-alone situations for T

A T-coded service may be payable when reported alone (no other payable physician fee schedule services on same date by same provider).
When two T codes are billed together with no additional services on the same date by the same individual provider, UnitedHealthcare may consider payment for the T code with the higher RVU and bundle the lower RVU T code into it (no separate payment for the lower RVU code).
If a T code is reported with any other service assigned status indicator A or R on the same date by the same provider, the T code will be bundled into the payable service and not paid separately.

ALL of the following

Codes with status indicator A are active and are paid separately under the physician fee schedule if covered (presence of A does not by itself indicate Medicare national coverage; carriers remain responsible for coverage decisions).

ALL of the following

Codes with status indicator R have special coverage instructions; if covered, the service is carrier priced. Many R codes are dental (D) codes or represent services covered only in unusual circumstances.

ALL of the following

UnitedHealthcare may publish edits and rebundling guidance separately; providers should refer to the published edits (by year/quarter under the 'Status Code' column) and the Rebundling Policy for details.

ALL of the following

Providers must submit accurate claims using CPT/HCPCS per CMS/NPFS guidelines; UnitedHealthcare applies these bundling rules when determining reimbursement for Medicaid products.

Status Indicators and Coding Implications

NPFS status indicator Tmixed

T (status indicator)

Codes with RVUs but only paid if there are no other physician fee schedule services payable billed on the same date by the same provider; otherwise bundled into the payable physician service. No modifier overrides this bundling; when two T codes are billed alone, the lower RVU may be bundled into the higher.

NPFS status indicator Amixed

A (status indicator)

Active codes paid separately under the physician fee schedule if covered; presence of A does not indicate a national Medicare coverage determination (carriers remain responsible for coverage decisions).

NPFS status indicator Rmixed

R (status indicator)

Restricted coverage; special coverage instructions apply. If covered, the service is carrier priced. Majority of codes with this indicator are dental (D codes); a limited number of CPT codes assigned when covered only in unusual circumstances.

Bundling condition for T

Bundling ruleCodes assigned NPFS status indicator T are bundled when any other payable physician fee schedule service is billed on the same date by the same individual provider; they are only paid if no other payable physician-fee-schedule service is billed that date by the same provider.

Modifier exceptionsNo modifier overrides will exempt codes with status indicator T from bundling into services for which payment is made.

Payment when reported aloneStatus indicator T codes have RVUs and payment amounts and may be paid when reported alone (i.e., when no other payable physician fee schedule service is billed the same date by the same provider).

Claims Submission and Billing Responsibilities

Documentation Required

Claims submission responsibility

You are responsible for submission of accurate claims using CPT/HCPCS in accordance with CMS/NPFS guidelines. Submit claims on the CMS-1500 form or the electronic equivalent and ensure codes reported correctly describe the services provided.

Use CPT, CMS or other coding guidelines referenced by UnitedHealthcare Community Plan.
File claims on CMS-1500 (or electronic equivalent); follow any system-specific submission requirements.

Key Term: Same Individual Physician or Qualified Provider

Same Individual Physician or Other Qualified Health Care Professional

Definition'Same Individual Physician or Other Qualified Health Care Professional' refers to the identical physician or other qualified health care professional who billed the services on the same date (per UnitedHealthcare application to CMS-1500 and electronic claims).

Scope of applicationApplies to services reported on the CMS-1500 form or its electronic equivalent and to all network and non‑network physicians and other qualified health care professionals under UnitedHealthcare Community Plan Medicaid.

Relevance to bundlingThe term is used to determine when NPFS status indicator T codes are bundled into other payable physician fee schedule services — bundling only applies when services are billed by the same individual provider on the same date.