OPPS Payment Status Indicators are assigned to every HCPCS code. The Payment Status Indicator Identifies whether the service described by the HCPCS code is paid under the OPPS and if so, whether payment is made separately or packaged.
The payment status indicator may also provide additional information about how the code is paid under the OPPS or under another payment system or fee schedule.
Example of a Payment Status Indicator
Services with Payment Status Indicator A are paid under a fee schedule or payment system other than the OPPS.
Services with payment status indicator N are paid under the OPPS, but their payment is packaged into payment for a separately paid service.
Services with payment status indicator T are paid separately under OPPS but a multiple procedure payment reduction applies when two or more services with a payment status indicator of T are billed on the same date of service.
List of Payment Status Indicators
The full list of status indicators and their definitions is published in Addendum D1 of the OPPS/ASC proposed and final rules each year.
The status indicator for each HCPCS code is shown in OPPS Addendum B. You can find all the information you need on the CMS website.
Where can I find the 2021 updates for the Payment Status Indicators?
You can find updates for payment status indicators (Addendum A and Addendum B Updates) here..