What type of indicator is assigned to every HCPCS/CPT code under the Medicare hospital outpatient prospective payment system?

Under the Medicare hospital outpatient prospective payment system (OPPS), every HCPCS (Healthcare Common Procedure Coding System) or CPT (Current Procedural Terminology) code is assigned a payment status indicator. This indicator plays a crucial role in determining how services and procedures are reimbursed within the outpatient setting.

Payment status indicators categorize items and services into specific groups that dictate their payment methodology. For instance, they help decide if a service is covered under Medicare, the type of payment it receives (such as whether it is paid per service, bundled into a service, or not paid at all), or if it is deemed not separately payable.

By having a payment status indicator linked to each code, healthcare providers can better understand the reimbursement landscape and tailor their billing practices accordingly, helping ensure compliance with Medicare regulations and optimizing reimbursement processes. This structured approach ultimately supports efficient management of outpatient services and aids in financial planning for healthcare providers.