Status Indicators at a Glance

The following are the payment status indicators and descriptions of the particular services each indicator identifies and an example code that applies to that indicator:

A: indicates services that are paid under some other method such as the DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies) fee schedule or the physician fee schedule.

Example: G0107, colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations.

C: indicates inpatient services that are not paid under the outpatient prospective payment system (OPPS).

Example: 75900, exchange of a previously placed arterial catheter during thrombolytic therapy with contrast monitoring, radiological supervision and interpretation.

E: indicates services for which payment is not allowed under the OPPS. In some instances, Medicare does not cover the service. In other instances, Medicare does not use the code in question but does use another code to describe the service.

Example: Q0186, paramedic intercept (PI), rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payers.

F: indicates corneal tissue acquisition costs, which are paid separately.

Example: V2785, processing, preserving and transporting corneal tissue.

G: indicates a current drug or biological for which payment is made under the transitional pass-through.

Example: C9011, injection, caffeine citrate, per 1 ml.

H: indicates a device for which payment is made under the transitional pass-through.

Example: C1980, catheter, Atlantis SR Coronary Imaging Catheter.

J: indicates a new drug or biological for which payment is made under the transitional pass-through.

Example: C1024, Quinopristin 150 mg/dalfopriston 350 mg.

K: indicates a non pass-through drug/biological (paid under OPPS).

Example: P9017, fresh frozen plasma (single donor), each unit.

N: indicates services that are incidental, with payment packaged into another service or APC group.

Example: P9612, catheterization for collection of specimen, single patient, all places of service

P: indicates services that are paid only in partial hospitalization programs.

Example: G0129, occupational therapy requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization treatment program, per day.

S: indicates significant procedures for which payment is allowed under the OPPS but to which the multiple procedure reduction does not apply.

Example: 94660, continuous positive airway pressure ventilation (CPAP), initiation and management.

T: indicates surgical services for which payment is allowed under the OPPS. Services with this payment indicator are the only services to which the multiple procedure payment reduction applies.

Example: 27305, fasciotomy, iliotibial (tenotomy), open

V: indicates medical visits for which payment is allowed under the OPPS.

Example: G0101, cervical or vaginal cancer screening; pelvic and clinical breast examination.

X: indicates ancillary services for which
payment is allowed under the OPPS.
Example: [...]

- Published on 2001-01-01