Status Indicators
“It is a payment indicator that identifies whether a service represented by a CPT or HCPCS code is payable under the OPPS APC or another payment system”
A – Services not paid under OPPS; paid under fee schedule or other
payment system, including unclassified drugs and biologicals reportable
under HCPCS code C9399
B – Non-allowed item or service for OPPS
C – Inpatient procedure
E – Non-allowed item or service (discontinued 01/01/2017)
E1 – Non-allowed item or service
E2 – Items and services for which pricing information and claims data are
not available
F – Corneal tissue acquisition; certain CRNA services
G – Drug/Biological pass-through
H – Pass-through device categories
J1 – Outpatient department services paid through a comprehensive APC
J2 – Hospital Part B services that may be paid through a comprehensive APC
K – Non pass-through drugs and non-implantable biologicals, including therapeutic radiopharmaceuticals
L – Influenza Vaccine; Pneumococcal Pneumonia Vaccine; Hepatitis B Vaccines; Covid-19 Vaccine; Monoclonal Antibody Therapy Product
M – Service not billable to the FI/MAC
N – Items and Services packaged into APC rates
P – Partial hospitalization service
Q1 – STVX-packaged codes
Q2 – T-packaged codes
Q3 – Codes that may be paid through a composite APC
Q4 – Conditionally packaged laboratory services
R – Blood and blood products
S – Significant procedure not subject to multiple procedure discounting
T – Significant procedure subject to multiple procedure discounting
U – Brachytherapy sources
V – Clinic or emergency department visit
W – Invalid HCPCS or Invalid revenue code with blank HCPCS
Y – Non-implantable DME
Z – Valid revenue code with blank HCPCS and no other SI assigned
Payment Indicators
1 – Paid standard hospital OPPS amount (status indicators J1, J2, R, S, T,U, V)
2 – Services not paid by OPPS Pricer; paid under fee schedule or other payment system (status indicators A, G, K)
3 – Not paid (status indicators E, M, Q1, Q2, Q3, Q4, W, Y), or not paid under OPPS (status indicators B, C, Z)
4 – Paid at reasonable cost (status indicator F, L)
5 – Paid standard amount for pass-through drug or biological (status indicator G) (discontinued 10/01/2016)
6 – Payment based on charge adjusted to cost (status indicator H)
7 – Additional payment for new drug or new biological
8 – Paid partial hospitalization per diem (status indicator P)
9 – No additional payment; payment included in line items with APCs (status indicator N; or no HCPCS code and certain revenue codes; or HCPCS codes G0176 – activity therapy, G0129 – occupational therapy, or G0177 – patient education and training services)
10 – Paid FQHC encounter payment
11 – Not paid or not included under FQHC encounter payment
12 – No additional payment, included in payment for FQHC encounter
13 – Paid FQHC encounter payment for New patient or IPPE/AWV
14 – Grandfathered tribal FQHC encounter payment
