Hot or Cold Packs: Bundling Denials

Denial Reason, Reason/Remark Code(s)

• B15 (Bundling): Payment adjusted because this procedure/service requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.
• CPT code: 97010

Resolution/Resources

• This code is listed as 'Status B' in the Medicare Physician Fee Schedule Database (MPFSDB), which means that payment for this service is always included in payment for other services performed on the same date that are reimbursed under the Medicare Physician Fee Schedule
• Physical Therapy status 'B' codes are codes for which payment is included in the basic allowance of another procedure. Regardless of whether submitted on a claim alone or in conjunction with another therapy code, a separate payment will never be made for the codes and the patient cannot be billed for these services.
• Do not submit these services to Palmetto GBA unless the patient specifically requests that you do so; for example, the patient requests a denial from Medicare to submit a claim to his/her secondary insurer

The following CPT codes for physical therapy services are designated as 'Status B' in the 2010 Medicare Physician Fee Schedule Database (MPFSDB):

• 97010
• 92605
• 92606
• 97602

Reference

• Find definitions of 'Status Indicators' in CMS Pub. 100-04, Chapter 23, Section 30.2.2
• Bundled Codes: Status B Indicator: When the Medicare Physician Fee Schedule Database is updated, CMS defines certain services that will not be reimbursed by Medicare Part B. Status B indicates: Payment for covered services is always bundled into payment for other services not specified. When these services are covered, payment for them is subsumed by the payment for the services to which they are incident (e.g., a telephone call from a hospital nurse regarding care of a patient). You cannot bill the patient for these services. The TC modifier is a HCPCS modifier, and the 26 modifier is a CPT modifier.