How do Status Indicator influence the reimbursement in Medical Billing?

A Status indicator explains the payment methodology for outpatient hospital services. It determines that under what payment system the service are paid.

It is appended with every HCPCS code to identify the particular services or procedure described by the code would be paid under the hospital OPPS.

Hospital outpatient services may include:-

  • Physician professional services.
  • Screening Mammography.
  • Physician services for a patient of ESRD.
  • Clinical diagnostic laboratory services.
  • EPO for ESRD patient.
  • Pulmonary Rehabilitation clinical trial.
  • Ambulance services.
  • Non- Implantable prosthetic and orthotic devices.
  • Speech, Physical & occupational Therapy.
  • Routine dialysis procedures for ESRD patient

Types of Indicator

Status Indicators are:-

A, B, C, D, E, F, G, H, K, L, M, N, P, Q, R, S, T, U, V, X & Y.

Some Important Fact:

  • Status indicator helps to determine the payment methodology for the services under the OPPS or another payment system such as IPPS.
  • Only one indicator can append with particular one CPT or HCPCS level II code.
  • HCPCS codes with status indicator K, N, P, Q, R, S, T, U, V & X are paid under OPPS.
  • The subset of drugs, biologics and devices eligible for pass-through payments under OPPS are assigned to status indicators G and H are also paid under OPPS with a seperate APC.
  • Status Indicator C append with only Inpatient procedures, that will not be reimbursed by OPPS, it will be reimbursed by IPPS.


3 responses to “How do Status Indicator influence the reimbursement in Medical Billing?”

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