CurrentWPS Health InsurancePolicy 1007

Status B Codes

This document governs reimbursement policy for services reported on UB-04 and CMS-1500 claims, specifying treatment of CMS 'Status B' codes for WPS Health Insurance commercial lines and applies to all network and non-network providers.

Policy Summary

PayerWPS Health Insurance

PolicyStatus B Codes

Policy CodePolicy 1007

Change TypeNo material changes

Effective DateOct 1, 2019

Next Review DateOct 1, 2026

Key ActionProviders must accurately document services and submit claims using valid codes following industry coding guidelines; Status B codes are not reimbursable by WPS.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Commerciallines of business covered

Not reimbursabletreatment of Status B codes

UB-04/CMS-1500claim form types

Annualreview frequency

Coverage Criteria for Status B Codes

Status B reimbursement criteria

WPS will not reimburse services reported with Status B codes and requires appropriate coding and documentation on standard claim forms.

Applies to services reported on UB-04 and CMS-1500 (and electronic equivalents).

Applies to all Commercial Lines of Business.

Applies to network and non-network physicians and other qualified health care professionals.

Services reported with Status B codes are not reimbursable by WPS.

Providers must accurately, completely, and legibly document services and submit claims using valid codes in accordance with industry standard coding guidelines (including but not limited to AMA CPT, HCPCS, CCI, DRG, CMS guidance).

Policy Summary

PayerWPS Health Insurance

PolicyStatus B Codes

Policy CodePolicy 1007

Change TypeNo material changes

Effective DateOct 1, 2019

Next Review DateOct 1, 2026

Key ActionProviders must accurately document services and submit claims using valid codes following industry coding guidelines; Status B codes are not reimbursable by WPS.

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.

Billing, Documentation, and Provider Responsibilities

Billing Rule

Billing and documentation requirements; Status B non-reimbursement

Providers must accurately, completely, and legibly document services and submit claims using valid codes coded per industry standard coding guidelines; WPS will not reimburse services reported with CMS Status B codes (codes listed with a “B” in the National Physician Fee Schedule).

Document services accurately, completely, and legibly on the medical record.
Submit claims on UB-04 or CMS-1500 (or electronic equivalent) using valid codes and industry-standard coding guidelines (AMA CPT, HCPCS, CCI, DRG, CMS guidance).
Do not expect reimbursement for services reported with Status B codes (listed with a “B” in the National Physician Fee Schedule).

Definitions and Clarifications

Status B codes

DefinitionStatus B codes: Codes listed with a 'B' in the National Physician Fee Schedule that are designated as not reimbursable by WPS.

Reimbursement stanceNot reimbursable by WPS when reported on claims.

Reference guidanceListed in the Status Code column of the National Physician Fee Schedule with a 'B' designation.

Related policySee WPS Venipuncture reimbursement policy for guidance on venous blood collection where applicable.

Provider documentation and coding responsibility

Documentation responsibilityProviders must accurately, completely, and legibly document services performed.

Coding responsibilityBilling offices must submit claims using valid codes and code appropriately per industry standard coding guidelines (e.g., AMA CPT, HCPCS, CCI, DRG, CMS guidance).

Claims processing standardWPS follows industry standards for billing modifiers and coding practices for contracted and non‑contracted providers; provider contract language may supersede except where indicated.

OpenPayer

Status B Codes

Coverage Criteria for Status B Codes

Status B Codes and Coding Guidance

Billing, Documentation, and Provider Responsibilities

Definitions and Clarifications