Products
InformationPayment Status Indicators/Codes -
| Ind./ Code | Description |
|---|---|
| A | Services furnished to a hospital outpatient that are paid under a fee schedule or payment system other than OPPS, for example: * Ambulance Services * Separately Payable Clinical Diagnostic Laboratory Services * Separately Payable Non-Implantable Prosthetics and Orthotics * Physical, Occupational, and Speech Therapy * Diagnostic Mammography * Screening Mammography * Unclassified drugs and biologicals reportable under HCPCS code C9399 - Fee Schedule or Other Payment System |
| B | Codes that are not recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x and 13x). - Not Recognized by Medicare |
| C | Inpatient Procedures - Paid as Inpatient |
| D | Discontinued Codes - Deleted Code |
| E1 | Not covered by any Medicare outpatient benefit category. Statutorily excluded by Medicare. Not reasonable and necessary. - Not Paid |
| E2 | For which pricing information and claims data are not available. - Not Paid |
| F | Corneal Tissue Acquisition; Certain CRNA Services - Paid at Reasonable Cost |
| G | Pass-Through Drugs and Biologicals - Separate APC Payment |
| H | Pass-Through Device Categories - Separate Cost-Based Pass-Through Payment |
| H1 | Non-opioid Medical Devices For Post-Surgical Pain Relief - Separate payment based on hospital’s charges adjusted to cost. |
| J1 | Hospital Part B services paid through a comprehensive APC - Paid under OPPS |
| J2 | Hospital Part B Services That May Be Paid Through a Comprehensive APC - Paid under OPPS |
| K | Non-Pass-Through Drugs and Nonimplantable Biologicals, Including Therapeutic Radiopharmaceuticals - Separate APC payment |
| K1 | Non-Opioid Drugs and Biologicals For Post-Surgical Pain Relief - Paid under OPPS; separate APC payment. |
| L | Influenza Vaccine; Pneumococcal Pneumonia Vaccine; Hepatitis B Vaccines; Covid-19 Vaccine; Monoclonal Antibody Therapy Product - Paid at Reasonable Cost |
| M | Items and Services Not Billable to the MAC - Not Paid Under OPPS |
| N | Items and Services Packaged into APC Rates - Payment is Packaged |
| P | Partial Hospitalization - Per Diem APC Payment |
| Q1 | STV-Packaged Codes - Paid under OPPS; Addendum B displays APC assignments when services are separately payable. (1) Packaged APC payment if billed on the same claim as a HCPCS code assigned status indicator “S”, “T”, or “V". (2) Composite APC payment if billed with specific combinations of services based on OPPS composite-specific payment criteria. Payment is packaged into a single payment for specific combinations of services. (3) In other circumstances, payment is made through a separate APC payment. |
| Q2 | T-Packaged Codes - Paid under OPPS; Addendum B displays APC assignments when services are separately payable. (1) Packaged APC payment if billed on the same date of service as a HCPCS code assigned status indicator "T." (2) In other circumstances, payment is made through a separate APC payment. |
| Q3 | Codes That May Be Paid Through a Composite APC - Paid under OPPS |
| Q4 | Conditionally packaged laboratory tests - Paid under OPPS or CLFS. |
| R | Blood and Blood Products - Separate APC Payment |
| S | Procedure or Service, Not Discounted When Multiple - Separate APC Payment |
| T | Procedure or Service, Multiple Procedure Reduction Applies - Separate APC Payment |
| U | Brachytherapy Sources - Separate APC Payment |
| V | Clinic or Emergency Department Visit - Separate APC Payment |
| Y | Non-Implantable Durable Medical Equipment - Paid Under DMEPOS Fee Schedule |
CPT copyright 2024 American Medical Association. All Rights Reserved.
