		
ADDENDUM D1.--PROPOSED OPPS PAYMENT STATUS INDICATORS FOR CY 2015		
Status Indicator	Item/Code/Service	OPPS Payment Status
A	"Services furnished to a hospital outpatient that are paid under a fee schedule or payment system other than OPPS, for example:"	Not paid under OPPS.  Paid by fiscal intermediaries/MACs under a fee schedule or payment system other than OPPS.
		Services are subject to deductible or coinsurance unless indicated otherwise. 
		
	?  Ambulance Services	
		
	?  Separately Payable Clinical Diagnostic Laboratory Services	Not subject to deductible or coinsurance.
	?  Separately Payable Non-Implantable Prosthetics and Orthotics 	
	"?  Physical, Occupational, and Speech Therapy"	
	?  Diagnostic Mammography	
		
	?  Screening Mammography	Not subject to deductible or coinsurance.
B	Codes that are not recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x and 13x).	Not paid under OPPS.
		
		"?  May be paid by fiscal intermediaries/MACs when submitted on a different bill type, for example, 75x (CORF), but not paid under OPPS."
		?  An alternate code that is recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x and 13x) may be available.
C	Inpatient Procedures	Not paid under OPPS.  Admit patient.  Bill as inpatient.
D	Discontinued Codes	Not paid under OPPS or any other Medicare payment system.
E	"Items, Codes, and Services:"	Not paid by Medicare when submitted on outpatient claims (any outpatient bill type).
	?  For which pricing information is not available	
	?  Not covered by any Medicare outpatient benefit category   	
	?  Statutorily excluded by Medicare    	
	?  Not reasonable and necessary 	
F	Corneal Tissue Acquisition; Certain CRNA Services and Hepatitis B Vaccines	Not paid under OPPS.  Paid at reasonable cost.
G	Pass-Through Drugs and Biologicals  	Paid under OPPS; separate APC payment.
H	Pass-Through Device Categories	Separate cost-based pass?through payment; not subject to copayment.
J1	Hospital Part B services paid through a comprehensive APC	"Paid under OPPS; all covered Part B services on the claim are packaged with the primary ""J1"" service for the claim, except services with OPPS SI=F,G, H, L and U; ambulance services; diagnostic and screening mammography; all preventive services; and certain Part B inpatient services."
K	"Nonpass-Through Drugs and Nonimplantable Biologicals, Including Therapeutic Radiopharmaceuticals"	Paid under OPPS; separate APC payment.
L	Influenza Vaccine; Pneumococcal Pneumonia Vaccine	Not paid under OPPS.  Paid at reasonable cost; not subject to deductible or coinsurance.
M	Items and Services Not Billable to the Fiscal Intermediary/MAC	Not paid under OPPS.
N	Items and Services Packaged into APC Rates	"Paid under OPPS; payment is packaged into payment for other services.  Therefore, there is no separate APC payment."
P	Partial Hospitalization	Paid under OPPS; per diem APC payment.
Q1	STV-Packaged Codes 	Paid under OPPS; Addendum B displays APC assignments when services are separately payable.
		"(1)  Packaged APC payment if billed on the same date of service as a HCPCS code assigned status indicator “S,” “T,” or “V.”"
		"(2)  In other circumstances, payment is made through a separate APC payment."
Q2	T-Packaged Codes 	Paid under OPPS; Addendum B displays APC assignments when services are separately payable.
		(1)  Packaged APC payment if billed on the same date of service as a HCPCS code assigned status indicator “T.”
		"(2)  In other circumstances, payment is made through a separate APC payment."
Q3	Codes That May Be Paid Through a Composite APC	Paid under OPPS; Addendum B displays APC assignments when services are separately payable.
		Addendum M displays composite APC assignments when codes are paid through a composite APC. 
		(1)  Composite APC payment based on OPPS composite-specific payment criteria.  Payment is packaged into a single payment for specific combinations of services.
		"(2)  In other circumstances, payment is made through a separate APC payment or packaged into payment for other services."
R	Blood and Blood Products 	Paid under OPPS; separate APC payment.
S	"Procedure or Service, Not Discounted When Multiple "	Paid under OPPS; separate APC payment.
T	"Procedure or Service, Multiple Procedure Reduction Applies"	Paid under OPPS; separate APC payment.
U	Brachytherapy Sources 	Paid under OPPS; separate APC payment.
V	Clinic or Emergency Department Visit	Paid under OPPS; separate APC payment.
Y	Non-Implantable Durable Medical Equipment	Not paid under OPPS.  All institutional providers other than home health agencies bill to DMERC.
