Payment Status Indicator List (2022) | Addendum A & Addendum B
The payment status indicator list is updated quarterly by OPPS and tells you if a HCPCS code is pay and how. Below you can download the complete list of payment status indicators.
1. What Is A Payment Status Indicator?
Every HCPCS code is assigned a ‘payment status indicator’ by OPPS. A payment status indicator identifies if an HCPCS code is paid by OPPS. It also tells you if the payment is packaged or made seperately.
A payment status indicator can provide extra information on how a HCPCS code is paid by OPPS or by a fee schedule or another payment system
Payment Status Indicator A: These services are paid by another payment system or fee schedule than OPPS.
Payment Status Indicator N: OPPS pays for these services but the payment is packaged into a separately paid service payment.
Payment Status Indicator T: OPPS pays for services that have a payment status indicator N but be aware that a multiple procedure payment reduction will be applied for services billed on the same service date.
Payment Status Indicators List
The OPPS website publishes Addendum A and Addendum B every 3 months. They are so called ‘snapshots’ of the satus indicators of HCPCS codes, OPPS payment rates, and APC groups for that specific quarter.
The updates of Addendum and B reflect the OPPS pricer changes and are part of the recurring update notification transmittals of OPPSS and updated quarterly and published on the CMS website.
References
https://www.govinfo.gov/content/pkg/FR-2021-02-25/pdf/2021-03852.pdf
https://www.cms.gov/license/ama?file=/files/zip/january-2022-opps-addendum.zip
https://www.cms.gov/license/ama?file=/files/zip/addendum-b-october-2022-correction.zip
