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What is the status indicator?

Codes that are not recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x and 13x).

User Bob  Sponge
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Final answer:

Status indicators are codes that determine reimbursement methodologies for healthcare services under OPPS. They are attached to HCPCS codes and used when billing for outpatient services. Specific status indicators reveal whether a service is not recognized by OPPS, affecting its Medicare reimbursement.

Step-by-step explanation:

Status indicators are codes used in the Outpatient Prospective Payment System (OPPS) to classify services and determine how they will be reimbursed. These indicators are attached to every service or procedure coded under the Healthcare Common Procedure Coding System (HCPCS) when billing for outpatient services. Each status indicator informs the billing party about the payment methodology for a particular service, such as whether the service is paid under a prospective payment system, subject to bundled payment rates, or not payable by Medicare. For example, if a service or item has a status indicator that specifies it is not recognized by OPPS, it means that when this code is submitted on an outpatient hospital Part B bill type (12x and 13x), it will not be reimbursed by Medicare.

User Pablo Fonseca
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