OPPS Payment Status Indicators

Medicare has assigned each HCPCS/CPT code a letter that signifies whether Medicare will reimburse the service and how it will be reimbursed. The indicator also helps in determining whether policy rules, such as packaging and discounting, apply. You will find the values listed below on the DDE claim page 2 (f11 line item detail) under OCE flags.

Values Description
A Services not paid under OPPS
B Non-Allowed item or service for OPPS
C Inpatient only procedure procedure not paid under OPPS
E Services not paid, non-allowed item or service
F Acquisition costs paid for Corneal tissue acquisition; certain CRNA services and hepatitis B vaccines
G Additional payment for Drug/Biological pass-through
H Additional payment for Pass-though device categories, brachytherapy sources, and radiopharmaceutical agents
J Additional payment for new drug or new biological pass-through (discontinued 04/01/2002 and replaced by status indicator G for all drugs/biologicals)
K Non pass-through drugs and biologicals, and blood and blood products
L Flu/PPV vaccines
M Service not billable to the FI
N No additional payment, payment included in line items with APCs for incidental service
P Paid Partial hospitalization per dium payment
Q Packaged services subject to separate payment based on criteria
S Significant procedure not subject to multiple procedure discounting
T Significant procedure subject to multiple procedure discounting
V Medical visit to clinic or emergency department
W Services not paid. Invalid HCPCS or invalid revenue code with blank HCPCS
X Ancillary service
Y Services not paid. Non-implantable DME, therapeutic shoes
Z Valid revenue code with blank HCPCS and no other SI assigned

 

Last Updated Apr 10, 2018