Oncology & Hematology Coding Alert

Try this easy-access chart

CMS uses lots of symbols and abbreviations in its physician fee schedule, and hunting down what they mean can be a labor-intensive chore in your already busy day. We-ve put the definitions for status indicators in the easy-to-use chart below.

Tip: If you don't want to cut the chart out, you can still access it quickly using our searchable Online Subscription System (OSS). If you haven't already signed up for this great free service, contact customer service at (800) 508-2582 or service@medville.com.

You can also see the official version in Federal Register issues that publish proposed fee schedules.

Size Up Your Code's Status Indicator

The PFS status indicator tells you whether the CPT/HCPCS code is in the pFS and whether Medicare will pay the code separately.

Example: Injection and intravenous infusion chemotherapy codes 96401-96417 all have A (Active) status. But 96523 (Irrigation of implanted venous access device for drug delivery systems) has status indicator T, which means when you provide an infusion on the same day as the irrigation, Medicare will only reimburse you for the infusion.

You can find the status indicator listed with the other payment indicators (for example, in the searchable PFS at www.cms.hhs.gov/apps/pfslookup/).

- A ~ Active code. When these codes are covered, Medicare will separately pay them. You-ll see RVUs for these codes, but individual carriers/contractors decide coverage if there's no national coverage determination for the service.

- B ~ Bundled code. Even when these codes are covered, payment is bundled into payment for other services. Any RVUs shown for these codes aren't used by Medicare.

- C ~ Carrier-priced code. Carriers determine RVUs and payment for these services, often case-by-case, depending on the documentation.a

- D ~ Deleted/discontinued code. Consider these codes at the beginning of the CY. They are subject to a 90-day grace period.

- E ~ Excluded from the PFS by regulation. You won't see RVUs or payment for these codes. Any payment for covered codes with -E- status is under reasonable charge procedures.

- F ~ Deleted/discontinued codes. This status is no longer effective. The difference between status D and F is that F codes were not subject to a 90-day grace period.

- G ~ Code not valid for Medicare purposes. This status is also no longer effective. It was used for codes Medicare didn't recognize that were subject to a 90-day grace period.

- H ~ Deleted modifier. If Medicare deleted a code's technical or professional component in 2000 or later, you-ll see the H status. You may also see the deleted component with the H indicator.

- I ~ Not valid for Medicare purposes. Use another code when reporting this service to Medicare. These codes aren't subject to a 90-day grace period.

- J ~ Anesthesia services. These codes help identify anesthesia services but don't have RVUs.

- M ~ Measurement codes. These codes are only used for reporting purposes.

- N ~ Noncovered service. Medicare won't pay you for these codes, even if the code is assigned RVUs.

- P ~ Bundled or excluded code. These codes don't have RVUs or separate payment. When an item or service with this status is covered as incident-to a physician's service and it is furnished on the same day as a physician's service, Medicare bundles the payment into the physician service. When the item or service is covered as other than incident-to a physician's service, that means Medicare excludes it from the PFS and pays the item or service under the Act's other payment provisions.

- R ~ Restricted coverage. Look for special coverage instructions for these codes. If you don't see RVUs for a covered service, consider it carrier-priced.

- T ~ Injections. There are RVUs for these services, but they are only paid if there are no other services payable under the PFS billed on the same date by the same provider. This indicator is another method of alerting you to bundling.

- X ~ Exclusion by law. These codes stand for items or services outside PFS --physicians- services-- definition. Don't expect RVUs or payment for these codes.