Medicare has assigned every CPT/HCPCS code with a specific status indicator. These indicators help in the payment of reimbursement process for different facility. For example, status indicator identifies whether the service described by the HCPCS code is paid under the OPPS (Outpatient Prospective Payment System) and if so, whether payment is made separately or packaged. You can refer the below image to understand about

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Below are the list of status indicators of OPPS

A Services not paid under OPPS

B Non-Allowed item or service for OPPS

C Inpatient only procedure not paid under OPPS

E Services not paid, non-allowed item or service

F Acquisition costs paid for Corneal tissue acquisition; certain CRNA services and hepatitis B vaccines

G Additional payment for Drug/Biological pass-through

H Additional payment for Pass-though device categories, brachytherapy sources, and radiopharmaceutical agents

J Additional payment for new drug or new biological pass-through (discontinued 04/01/2002 and replaced by status indicator G for all drugs/biologicals)

K Non pass-through drugs and biologicals, and blood and blood products

L Flu/PPV vaccines

M Service not billable to the FI

N No additional payment, payment included in line items with APCs for incidental service

P Paid Partial hospitalization per dium payment

Q Packaged services subject to separate payment based on criteria

S Significant procedure not subject to multiple procedure discounting

T Significant procedure subject to multiple procedure discounting

V Medical visit to clinic or emergency department

W Services not paid. Invalid HCPCS or invalid revenue code with blank HCPCS

X Ancillary service

Y Services not paid. Non-implantable DME, therapeutic shoes

Z Valid revenue code with blank HCPCS and no other SI assigned

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Detail Definition of Status indicators

STATUS INDICATOR A – ACTIVE CODE

These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an A status indicator does not mean that Medicare has made a national coverage determination regarding the service and that payment is guaranteed. In most instances, the Medicare Contractors remain responsible for coverage decisions.

STATUS INDICATOR B – BUNDLED CODE

Payment for the service, when covered, is always bundled into payment for other services. There will be no RVUs or payment amount for these codes, and no separate payment is made. When these services are covered, payment for them is included in the payment for the services to which they are incident. For example, the receipt of a telephone call from a hospital nurse regarding patient status is bundled into the payment for the inpatient visit. In our sample schedule, placement of a vascular closure device (G0269) is bundled and not paid separately.

STATUS INDICATOR C – CARRIERS PRICE THE CODE

Medicare Contractors will establish RVUs and payment amounts for these services, generally on an individual case basis following review of documentation, such as an operative report. CPT Category III codes 0075T, Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; initial vessel, and 0076T, Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; each additional vessel (List separately in addition to code for primary procedure),are status indicator C codes.

STATUS INDICATOR E – EXCLUDED FROM THE PHYSICIAN FEE SCHEDULE BY REGULATION

These codes are for items and/or service that CMS has chosen to exclude from the physician fee schedule payment by regulation. No RVUs or payment amounts are shown, and no payment may be made under the physician fee schedule for these codes. HCPCS Level II codes G0259, Injection procedure for sacroiliac joint; arthrography,and G0260, Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography, are status indicator E codes. These procedures were created for hospitals to recognize the differing cost based on the substance injected. Since the hospital, not the physician, purchases the drug, the physician payment is the same for the injection procedure under the CPT code describing sacroiliac joint injection. The physician would report these procedures with code 27096, Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid, with image guidance (fluoroscopy or CT), including arthrography when performed, which is a status indicator E procedure.

STATUS INDICATOR I – NOT VALID FOR MEDICARE PURPOSES

Medicare uses another code for reporting of, and payment for, these services. Status indicator I is a commonly used indicator. It is most often used on HCPCS Level II codes describing supply items. It is also assigned to all the CPT Category II codes, as they are for performance monitoring and not payment. Code 76140 is assigned status indicator I.

STATUS INDICATOR N – NONCOVERED SERVICES

These services are noncovered by Medicare. Code 37216, Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; without distal embolic protection, is status indicator N. Medicare only covers cervical carotid stent placement when embolization protection is used. When status indicator N procedures are performed, an ABN should be signed by the patient and the code billed with a -GA modifier appended. The patient may then be held liable for payment of the procedure.

STATUS INDICATOR R – RESTRICTED COVERAGE

Special coverage instructions apply. The majority of codes to which this status indicator will be assigned are the alpha-numeric dental codes which begin with “D;” however, codes 37215 (carotid stent placement with embolic protection device) and 61630 (intracranial balloon angioplasty) are assigned status indicator R. If the service is covered, it is Contractor priced.

STATUS INDICATOR T – PAID AS ONLY SERVICE

There are RVUs and payment amounts for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the physician services for which payment is made. Code 36598, Contrast injection(s) for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report, is a status indicator T procedure.

STATUS INDICATOR X – STATUTORY EXCLUSION

These codes represent an item or service that is not in the statutory definition of “physician services” for physician fee schedule payment purposes. No RVUs or payment amounts are shown for these codes, and no payment will be made under the physician fee schedule. Examples are ambulance services and clinical diagnostic laboratory services.