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A Sound Knowledge of : Status Indicator A, B, C & D

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161 Status Indicator A

Status Indicator A covers services provide to a hospital outpatient setting.

These services are paid under a fee schedule or payment system other than the OPPS.

Services Covered:-

  • Ambulance Services
  • EPO for ESRD Patient
  • Diagnostic Mammography
  • Physical, Occupational, and Speech therapy
  • Routine Dialysis services for ESRD

These services are not paid under OPPS. Its paid by FI/MACs under a fee schedule or payment system other than OPPS. Above services are subject to deductible or coinsurance.

  • Services are subjected to deductible or coinsurance.
  • Clinical Diagnostic Laboratory Services
  • Non- Implantable Prosthetic and Orthotic  Devices
  • Screening Mammography

These services are not subject to deductible or co-insurance.

161 Status Indicator B

Codes that are append with status indicator B, not recognised by  OPPS when submitted on an outpatient hospital Part B bill type (12x and 13x).

These services are also not paid under OPPS.

It can be paid by Intermediaries/MACs when submitted on a different bill type like 75x  Comprehensive Outpatient Rehabilitation Facility (CORF).

161 Status Indicator C

Status Indicator C can be append with Inpatient Procedure. The patient must be admitted and services will be reimbursed under Inpatient Prospective Payment System.

These services are provided to the inpatient and are paid under IPPS. 

161 Status Indicator D

Status Indicator D is used with Discontinued codes. These codes or services are not covered by CMS statue.

These procedure codes are not payable under OPPS or any other medicare 

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