List of Status Indicators
A = Active code. Medicare pays these codes separately under the physician fee schedule (PFS), if covered. Codes with this status include RVUs and payment amounts. The presence of an A indicator doesn’t mean that Medicare has made a national coverage determination about the service. A/B MACs (B) stay responsible for coverage decisions in the absence of a national Medicare policy.
B = Payment for covered services are always bundled into payment for other services not specified. No RVUs or payment amounts exist for these codes and Medicare never makes separate payment. When Medicare covers these services, we include payment for them in the payment for the services to which they’re incident. An example is a telephone call from a hospital nurse about the care of a patient.
C = A/B MACs (B) price the code. A/B MACs (B) set up RVUs and payment amounts for these services, generally on an individual case-by-case basis following review of documentation such as an operative report.
E = Excluded from physician fee schedule by regulation. CMS excludes these codes for items or services from the fee schedule payment by regulation. The MPFSDB Status Indicators table doesn’t show any RVUs or payment amounts and makes no payment under the fee schedule for these codes. Payment for them, when covered, continues under reasonable charge procedures.
I = Not valid for Medicare purposes. Medicare uses another code for reporting of, and payment for, these services. This code isn’t subject to a 90-day grace period.
J = Anesthesia services (no relative value units or payment amounts for anesthesia codes on the database, only used to facilitate the identification of anesthesia services.)
L = Local codes. A/B MACs (B) will apply this status to all local codes in effect on January 1, 1998, or subsequently approved by central office for use. A/B MACs (B) will complete the RVUs and payment amounts for these codes.
M = Measurement codes. Used for reporting purposes only.
N = Non-covered service. Medicare carries these codes on the HCPCS tape as noncovered services.
P = Bundled and excluded codes. No RVUs exist for these services. Medicare doesn’t make separate payment for them under the fee schedule. If we cover the item or service as incident to a physician service and you provide it on the same day as a physician service, we bundle payment for it into the payment for the physician service to which it’s incident. An example is an elastic bandage a physician provided incident to a physician service. If Medicare covers the item or service as other than incident to a physician service, we exclude it from the fee schedule (for example, colostomy supplies) and pay it under the other payment provision of the Social Security Act.
Q = Therapy functional information code. Used for reporting purposes only. This indicator is no longer effective beginning with the 2020 fee schedule as of January 1, 2020.
R = Restricted coverage. Special coverage instructions apply.
T = RVUs and payment amounts exist for these services. Medicare only pays these codes if there are no other services payable under the physician fee schedule (PFS) billed on the same date by the same provider.
If Medicare pays the same provider for any other services billed on the same date under the PFS, we bundle these services into the physician services.
X = Statutory exclusion. These codes stand for an item or service that isn’t in the legal definition of physician services for fee schedule payment purposes. The MPFSDB Status Indicators table shows no RVUs or payment amounts for these codes and makes no payment under the PFS. Examples: Medicare excludes ambulance services and clinical diagnostic laboratory services.
