TL;DR
Every HCPCS code in the hospital outpatient prospective payment system carries a status indicator that says whether the line is paid separately, packaged, paid under another fee schedule or not paid. The I/OCE 27.3.0 tables define 30 indicators; the October 2026 Addendum B uses 28 of them across 18,431 codes, with J1 comprehensive APCs covering 3,413 codes in 73 APCs.
October 2026 at a glance
- Status indicators defined
- 30
- I/OCE 27.3.0
- Used in Addendum B
- 28
- W and Z are claim-level outcomes
- Addendum B codes
- 18,431
- 6,735 HCPCS Level II
- Comprehensive APCs (J1)
- 73
- of 1,061 APCs in Addendum A
- Payment indicators
- 17
- ASC payment indicators
- 22
- Addendum DD1
The most common indicators in the October Addendum B are J1 (3,413 codes), N (2,088 codes), A (2,075 codes), M (1,494 codes). Counts are HCPCS and CPT codes in the addendum; dental codes (847 rows) are left out, and no code descriptors are shown.
The status indicator is one of the fields the Integrated Outpatient Code Editor checks before a hospital outpatient claim is paid. When a line fails, the remittance carries an I/OCE edit number; the I/OCE edit list gives each edit's disposition and the CARC and RARC codes that usually accompany it.
Every OPPS status indicator
The definition column is the I/OCE table text. The payment indicator is the second flag the I/OCE returns for the line; the counts show how many codes in the October 2026 Addendum B carry each status and how many APCs in Addendum A are assigned it.
| SI | Definition (I/OCE) | Payment indicator | Addendum B codes | Level II | APCs |
|---|---|---|---|---|---|
| A | Services not paid under OPPS; paid under fee schedule or other payment system | 2: Paid under fee schedule or other payment system (status indicator: A, G, K) | 2,075 | 1,277 | 0 |
| B | Non-allowed item or service for OPPS | 3: Not paid (status indicator: Q, Q1, Q2, Q3, Q4, M, W, Y, E, E1, E2) or not paid under OPPS (status indicator: B, C, Z) | 486 | 250 | 0 |
| C | Inpatient procedure | 3: Not paid (status indicator: Q, Q1, Q2, Q3, Q4, M, W, Y, E, E1, E2) or not paid under OPPS (status indicator: B, C, Z) | 1,448 | 4 | 0 |
| E1 | Non-allowed item or service | 3: Not paid (status indicator: Q, Q1, Q2, Q3, Q4, M, W, Y, E, E1, E2) or not paid under OPPS (status indicator: B, C, Z) | 1,449 | 533 | 0 |
| E2 | Items and services for which pricing information and claims data are not available | 3: Not paid (status indicator: Q, Q1, Q2, Q3, Q4, M, W, Y, E, E1, E2) or not paid under OPPS (status indicator: B, C, Z) | 51 | 47 | 0 |
| F | Corneal Tissue Acquisition; Certain CRNA Services | 4: Paid at reasonable cost (status indicator: F, L) | 1 | 1 | 0 |
| G | Drug/Biological Pass-through | 2: Paid under fee schedule or other payment system (status indicator: A, G, K) | 106 | 106 | 106 |
| H | Pass-through device categories | 6: Payment based on charge adjusted to cost (status indicator: H) | 21 | 21 | 21 |
| H1 | Non-Opioid Medical Devices for Post-Surgical Pain Relief | 6: Payment based on charge adjusted to cost (status indicator: H) | 13 | 13 | 13 |
| J1 | Hospital Part B services paid through a comprehensive APC | 1: Paid standard hospital OPPS amount (status indicator: J1, J2, R, S, T, U, V, X) | 3,413 | 41 | 73 |
| J2 | Hospital Part B services that may be paid through a comprehensive APC | 1: Paid standard hospital OPPS amount (status indicator: J1, J2, R, S, T, U, V, X) | 13 | 7 | 1 |
| K | Nonpass-Through Drugs and Nonimplantable Biologicals, Including Radiopharmaceuticals | 2: Paid under fee schedule or other payment system (status indicator: A, G, K) | 552 | 541 | 552 |
| K1 | Non-Opioid Drugs and Biologicals for Post-Surgical Pain Relief | 2: Paid under fee schedule or other payment system (status indicator: A, G, K) | 7 | 7 | 7 |
| L | Influenza Vaccine; Pneumococcal Pneumonia Vaccine; Hepatitis B Vaccines; Covid-19 Vaccine; Monoclonal Antibody Therapy Product | 4: Paid at reasonable cost (status indicator: F, L) | 51 | 12 | 0 |
| M | Service not billable to the FI/MAC | 3: Not paid (status indicator: Q, Q1, Q2, Q3, Q4, M, W, Y, E, E1, E2) or not paid under OPPS (status indicator: B, C, Z) | 1,494 | 1,381 | 0 |
| N | Items and Services packaged into APC rates | 9: No additional payment, payment included in line items with APCs (status indicator: N) | 2,088 | 1,151 | 0 |
| P | Partial Hospitalization or Intensive Outpatient Program | 8: Paid partial hospitalization per diem (status indicator: P) | 4 | 4 | 8 |
| Q1 | STV-Packaged Codes | 3: Not paid (status indicator: Q, Q1, Q2, Q3, Q4, M, W, Y, E, E1, E2) or not paid under OPPS (status indicator: B, C, Z) | 685 | 9 | 0 |
| Q2 | T-Packaged codes | 3: Not paid (status indicator: Q, Q1, Q2, Q3, Q4, M, W, Y, E, E1, E2) or not paid under OPPS (status indicator: B, C, Z) | 179 | 4 | 0 |
| Q3 | Codes that may be paid through a composite APC | 3: Not paid (status indicator: Q, Q1, Q2, Q3, Q4, M, W, Y, E, E1, E2) or not paid under OPPS (status indicator: B, C, Z) | 183 | 25 | 0 |
| Q4 | Conditionally packaged laboratory services | 3: Not paid (status indicator: Q, Q1, Q2, Q3, Q4, M, W, Y, E, E1, E2) or not paid under OPPS (status indicator: B, C, Z) | 1,367 | 8 | 0 |
| R | Blood and blood products | 1: Paid standard hospital OPPS amount (status indicator: J1, J2, R, S, T, U, V, X) | 41 | 41 | 41 |
| S | Procedure or service, not discounted when multiple | 1: Paid standard hospital OPPS amount (status indicator: J1, J2, R, S, T, U, V, X) | 693 | 103 | 123 |
| S1 | Skin substitute product paid separately | 1: Paid standard hospital OPPS amount (status indicator: J1, J2, R, S, T, U, V, X) | 328 | 328 | 3 |
| T | Procedure or service, multiple reduction applies | 1: Paid standard hospital OPPS amount (status indicator: J1, J2, R, S, T, U, V, X) | 862 | 15 | 85 |
| U | Brachytherapy sources | 1: Paid standard hospital OPPS amount (status indicator: J1, J2, R, S, T, U, V, X) | 17 | 17 | 17 |
| V | Clinic or emergency department visit | 1: Paid standard hospital OPPS amount (status indicator: J1, J2, R, S, T, U, V, X) | 23 | 8 | 11 |
| W | Invalid HCPCS or Invalid revenue code with blank HCPCS | 3: Not paid (status indicator: Q, Q1, Q2, Q3, Q4, M, W, Y, E, E1, E2) or not paid under OPPS (status indicator: B, C, Z) | 0 | 0 | 0 |
| Y | Non-implantable DME | 3: Not paid (status indicator: Q, Q1, Q2, Q3, Q4, M, W, Y, E, E1, E2) or not paid under OPPS (status indicator: B, C, Z) | 781 | 781 | 0 |
| Z | Valid revenue with blank HCPCS and no other SI assigned | 3: Not paid (status indicator: Q, Q1, Q2, Q3, Q4, M, W, Y, E, E1, E2) or not paid under OPPS (status indicator: B, C, Z) | 0 | 0 | 0 |
How each group of indicators is paid
The status in Addendum B is the starting point. The I/OCE can change it on the claim: a conditionally packaged code becomes N or a payable status depending on what else is billed, a comprehensive APC packages most other lines, and the final status of a line is inherited from the APC that pays it. The groups below follow the processing rules in the I/OCE specifications.
Paid separately through an APC: S, T, V, S1, R, U
These lines are paid the APC rate (payment indicator 1). Procedures with status T are subject to multiple-procedure discounting: the T line with the highest payment is paid in full and every other T line on the claim is discounted, unless modifier 76, 77, 78 or 79 applies. Status S procedures are not discounted. Status V marks a clinic or emergency department visit, which pays even on the day of an S or T procedure when it is significant and separately identifiable. S: 693 codes; T: 862 codes; V: 23 codes; S1: 328 codes; R: 41 codes; U: 17 codes.
Comprehensive APCs: J1, J2
A J1 procedure on a hospital outpatient claim (bill type 013x) is assigned a comprehensive APC that pays one amount for the whole claim: other services are packaged into it. Excluded from that packaging are, among others, ambulance, brachytherapy sources (U), mammography, therapy services, pass-through drugs and devices (G, H, H1), non-opioid pain relief drugs (K1), preventive vaccines (L) and self-administered drugs. J2 services, comprehensive observation, may be paid through a comprehensive APC when the claim meets its criteria. J1: 3,413 codes; J2: 13 codes.
Packaged or conditionally packaged: N, Q1, Q2, Q3, Q4
N lines pay nothing on their own; their cost is in the APC of the separately paid service. Q1 codes are packaged when the claim also carries a payable S, T or V service and paid separately otherwise; Q2 codes are packaged with a payable T or J1 procedure. Q3 codes may combine into a composite APC that pays one amount for a service normally reported with several codes. Q4 laboratory tests are packaged on a claim with other payable OPPS services and otherwise paid under the clinical laboratory fee schedule (the final status becomes A). N: 2,088 codes; Q1: 685 codes; Q2: 179 codes; Q3: 183 codes; Q4: 1,367 codes.
Drugs, biologicals and devices: G, K, K1, H, H1
G marks a drug or biological with pass-through status, K a separately payable drug, biological or radiopharmaceutical without it, and K1 a non-opioid drug for post-surgical pain relief. G, K and K1 carry payment indicator 2, so the OPPS Pricer does not price them from an APC rate; separately payable drugs are generally paid at ASP-based amounts. H and H1 are pass-through device categories and non-opioid pain relief devices, paid at charges adjusted to cost (payment indicator 6). G: 106 codes; K: 552 codes; K1: 7 codes; H: 21 codes; H1: 13 codes.
Paid under another payment system: A, F, L, P
Status A services are paid under a fee schedule or another payment system, for example clinical laboratory tests under the clinical laboratory fee schedule; since 2023 unclassified drugs reported with C9399 are also status A. F (corneal tissue acquisition and certain CRNA services) and L (influenza, pneumococcal, hepatitis B and COVID-19 vaccines and certain monoclonal antibody products) are paid at reasonable cost. P is partial hospitalization or an intensive outpatient program, paid a per diem. A: 2,075 codes; F: 1 codes; L: 51 codes; P: 4 codes.
Not paid on the outpatient claim: B, C, E1, E2, M, W, Y, Z
C is an inpatient-only procedure, not paid when furnished to an outpatient. B codes are not recognized under OPPS (an alternate code may be available), E1 items are not payable by Medicare, and E2 items have no pricing information or claims data. M services are not billable to the Medicare Administrative Contractor, and Y non-implantable equipment is billed to the DME contractor. W and Z are I/OCE outcomes for an invalid code or a revenue code reported without a HCPCS code; no HCPCS code carries them in Addendum B. B: 486 codes; C: 1,448 codes; E1: 1,449 codes; E2: 51 codes; M: 1,494 codes; Y: 781 codes.
Payment indicators
Alongside the status indicator, the I/OCE returns a payment indicator that tells the OPPS Pricer how to treat the line. Indicators 10 to 16 apply to federally qualified health center claims.
| PI | Definition (I/OCE) | Status indicators mapped |
|---|---|---|
| 0 | No payment indicator assigned | — |
| 1 | Paid standard hospital OPPS amount (status indicator: J1, J2, R, S, T, U, V, X) | J1, J2, R, S, S1, T, U, V |
| 2 | Paid under fee schedule or other payment system (status indicator: A, G, K) | A, G, K, K1 |
| 3 | Not paid (status indicator: Q, Q1, Q2, Q3, Q4, M, W, Y, E, E1, E2) or not paid under OPPS (status indicator: B, C, Z) | B, C, E1, E2, M, Q1, Q2, Q3, Q4, W, Y, Z |
| 4 | Paid at reasonable cost (status indicator: F, L) | F, L |
| 5 | Paid standard amount for pass-through drug or biological (status indicator: G) | — |
| 6 | Payment based on charge adjusted to cost (status indicator: H) | H, H1 |
| 7 | Additional payment for new drug or new biological (status indicator: J) | — |
| 8 | Paid partial hospitalization per diem (status indicator: P) | P |
| 9 | No additional payment, payment included in line items with APCs (status indicator: N) | N |
| 10 | Paid FQHC encounter payment | — |
| 11 | Not paid or not included under FQHC encounter payment | — |
| 12 | No additional payment, included in payment for FQHC encounter | — |
| 13 | Paid FQHC encounter payment for new patient or IPPE/AWV | — |
| 14 | Grandfathered tribal FQHC encounter payment | — |
| 15 | FQHC IOP encounter payment | — |
| 16 | Wrap-around payment for FQHCs that contract with Medicare Advantage (MA) organizations | — |
The 73 comprehensive APCs (status J1)
Each J1 APC pays one national unadjusted amount for the primary procedure and the services packaged with it; the hospital's wage index adjusts the labor-related share. Titles, weights and rates are from Addendum A.
| APC | APC group title | Relative weight | Payment rate |
|---|---|---|---|
| 5072 | Level 2 Excision/Biopsy/Incision and Drainage | 18.4584 | $1,687.37 |
| 5073 | Level 3 Excision/Biopsy/Incision and Drainage | 32.4633 | $2,967.63 |
| 5091 | Level 1 Breast/Lymphatic Surgery and Related Procedures | 43.7591 | $4,000.24 |
| 5092 | Level 2 Breast/Lymphatic Surgery and Related Procedures | 74.2109 | $6,783.99 |
| 5093 | Level 3 Breast/Lymphatic Surgery and Related Procedures | 91.3463 | $8,350.42 |
| 5094 | Level 4 Breast/Lymphatic Surgery and Related Procedures | 154.0167 | $14,079.44 |
| 5112 | Level 2 Musculoskeletal Procedures | 17.9710 | $1,642.82 |
| 5113 | Level 3 Musculoskeletal Procedures | 36.5681 | $3,342.87 |
| 5114 | Level 4 Musculoskeletal Procedures | 81.0959 | $7,413.38 |
| 5115 | Level 5 Musculoskeletal Procedures | 143.4859 | $13,116.76 |
| 5116 | Level 6 Musculoskeletal Procedures | 195.9590 | $17,913.59 |
| 5117 | Level 7 Musculoskeletal Procedures | 303.2514 | $27,721.73 |
| 5153 | Level 3 Airway Endoscopy | 19.8922 | $1,818.45 |
| 5154 | Level 4 Airway Endoscopy | 41.6682 | $3,809.10 |
| 5155 | Level 5 Airway Endoscopy | 78.8746 | $7,210.32 |
| 5163 | Level 3 ENT Procedures | 17.3406 | $1,585.19 |
| 5164 | Level 4 ENT Procedures | 37.0538 | $3,387.27 |
| 5165 | Level 5 ENT Procedures | 66.1604 | $6,048.05 |
| 5166 | Cochlear Implant Procedure | 368.4984 | $33,686.28 |
| 5182 | Level 2 Vascular Procedures | 17.5928 | $1,608.25 |
| 5183 | Level 3 Vascular Procedures | 35.2882 | $3,225.87 |
| 5184 | Level 4 Vascular Procedures | 62.1890 | $5,685.01 |
| 5191 | Level 1 Endovascular Procedures | 36.2320 | $3,312.15 |
| 5192 | Level 2 Endovascular Procedures | 63.6092 | $5,814.84 |
| 5193 | Level 3 Endovascular Procedures | 129.0185 | $11,794.23 |
| 5194 | Level 4 Endovascular Procedures | 204.8755 | $18,728.69 |
| 5200 | Implantation Wireless PA Pressure Monitor | 320.5669 | $29,304.62 |
| 5211 | Level 1 Electrophysiologic Procedures | 13.6073 | $1,243.91 |
| 5212 | Level 2 Electrophysiologic Procedures | 87.1695 | $7,968.60 |
| 5213 | Level 3 Electrophysiologic Procedures | 292.1182 | $26,703.99 |
| 5222 | Level 2 Pacemaker and Similar Procedures | 92.4862 | $8,454.63 |
| 5223 | Level 3 Pacemaker and Similar Procedures | 116.8121 | $10,678.38 |
| 5224 | Level 4 Pacemaker and Similar Procedures | 215.2698 | $19,678.89 |
| 5231 | Level 1 ICD and Similar Procedures | 248.5955 | $22,725.36 |
| 5232 | Level 2 ICD and Similar Procedures | 350.8038 | $32,068.73 |
| 5244 | Level 4 Blood Product Exchange and Related Services | 702.9866 | $64,263.52 |
| 5302 | Level 2 Upper GI Procedures | 21.4458 | $1,960.47 |
| 5303 | Level 3 Upper GI Procedures | 43.0890 | $3,938.98 |
| 5313 | Level 3 Lower GI Procedures | 31.0209 | $2,835.78 |
| 5331 | Complex GI Procedures | 67.8487 | $6,202.39 |
| 5341 | Level 1 Abdominal/Peritoneal/Biliary and Related Procedures | 40.0148 | $3,657.95 |
| 5342 | Level 2 Abdominal/Peritoneal/Biliary and Related Procedures | 72.3518 | $6,614.04 |
| 5361 | Level 1 Laparoscopy and Related Services | 67.5652 | $6,176.47 |
| 5362 | Level 2 Laparoscopy and Related Services | 118.7997 | $10,860.07 |
| 5372 | Level 2 Urology and Related Services | 7.7930 | $712.40 |
| 5373 | Level 3 Urology and Related Services | 23.3623 | $2,135.66 |
| 5374 | Level 4 Urology and Related Services | 39.3954 | $3,601.33 |
| 5375 | Level 5 Urology and Related Services | 59.9237 | $5,477.93 |
| 5376 | Level 6 Urology and Related Services | 105.7977 | $9,671.50 |
| 5377 | Level 7 Urology and Related Services | 147.4509 | $13,479.22 |
| 5378 | Level 8 Urology and Related Services | 231.6364 | $21,175.04 |
| 5414 | Level 4 Gynecologic Procedures | 36.1783 | $3,307.24 |
| 5415 | Level 5 Gynecologic Procedures | 55.9077 | $5,110.80 |
| 5416 | Level 6 Gynecologic Procedures | 82.8754 | $7,576.05 |
| 5431 | Level 1 Nerve Procedures | 21.8238 | $1,995.02 |
| 5432 | Level 2 Nerve Procedures | 38.1791 | $3,490.14 |
| 5433 | Level 3 Nerve Procedures | 98.0794 | $8,965.93 |
| 5461 | Level 1 Neurostimulator and Related Procedures | 39.0727 | $3,571.83 |
| 5462 | Level 2 Neurostimulator and Related Procedures | 71.2250 | $6,511.03 |
| 5463 | Level 3 Neurostimulator and Related Procedures | 124.5314 | $11,384.04 |
| 5464 | Level 4 Neurostimulator and Related Procedures | 216.8168 | $19,820.31 |
| 5465 | Level 5 Neurostimulator and Related Procedures | 344.8675 | $31,526.06 |
| 5471 | Implantation of Drug Infusion Device | 201.4356 | $18,414.24 |
| 5491 | Level 1 Intraocular Procedures | 25.7924 | $2,357.81 |
| 5492 | Level 2 Intraocular Procedures | 46.1954 | $4,222.95 |
| 5493 | Level 3 Intraocular Procedures | 59.4712 | $5,436.56 |
| 5494 | Level 4 Intraocular Procedures | 162.1211 | $14,820.30 |
| 5495 | Level 5 Intraocular Procedures | 155.9391 | $14,255.17 |
| 5496 | Level 6 Intraocular Procedures | 183.9672 | $16,817.36 |
| 5503 | Level 3 Extraocular, Repair, and Plastic Eye Procedures | 26.5709 | $2,428.98 |
| 5504 | Level 4 Extraocular, Repair, and Plastic Eye Procedures | 43.9375 | $4,016.55 |
| 5627 | Level 7 Radiation Therapy | 82.3149 | $7,524.82 |
| 5881 | Ancillary Outpatient Services When Patient Dies | 155.6515 | $14,228.88 |
ASC payment indicators
Ambulatory surgical centers use their own indicators, defined in ASC Addendum DD1. Covered surgical procedures are listed in Addendum AA (4,801 codes in October 2026) and covered ancillary services, such as drugs, devices and imaging furnished with a covered procedure, in Addendum BB (2,487 codes). The counts below exclude dental codes, and no descriptors are shown.
| PI | Definition (Addendum DD1) | AA codes | BB codes |
|---|---|---|---|
| A2 | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | 2,011 | 0 |
| B5 | Alternative code may be available; no payment made | 0 | 0 |
| D1 | Ancillary dental service/item; no separate payment made. | 0 | 0 |
| D2 | Non office-based dental procedure added in CY 2024 or later. | 1 | 0 |
| D5 | Deleted/discontinued code; no payment made. | 1 | 10 |
| F4 | Corneal tissue acquisition, hepatitis B vaccine; paid at reasonable cost. | 0 | 8 |
| G2 | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | 976 | 0 |
| H2 | Brachytherapy source paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate. | 0 | 17 |
| J7 | OPPS pass-through device paid separately when provided integral to a surgical procedure on ASC list; payment contractor-priced. | 0 | 21 |
| J8 | Device-intensive procedure; paid at adjusted rate. | 784 | 0 |
| K2 | Drugs, biologicals, and radiopharmaceuticals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate. | 0 | 634 |
| K5 | Items, codes, and services for which pricing information and claims data are not available. No payment made. | 0 | 48 |
| K7 | Unclassified drugs and biologicals; payment contractor-priced. | 0 | 2 |
| L1 | Influenza vaccine; pneumococcal vaccine. Packaged item/service; no separate payment made. | 0 | 36 |
| L6 | Special payment; New Technology Intraocular Lens (NTIOL) or qualifying non-opioid devices | 0 | 13 |
| N1 | Packaged service/item; no separate payment made. | 502 | 950 |
| P2 | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight. | 72 | 0 |
| P3 | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | 403 | 0 |
| R2 | Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight. | 51 | 0 |
| S2 | Skin substitute supply group; paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate. | 0 | 328 |
| Z2 | Radiology or diagnostic service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight. | 0 | 336 |
| Z3 | Radiology or diagnostic service paid separately when provided integral to a surgical procedure on ASC list; payment based on MPFS nonfacility PE RVUs. | 0 | 84 |
ASC comment indicators
| CI | Meaning (Addendum DD2) |
|---|---|
| CH | Active HCPCS code in current year and next calendar year, payment indicator assignment has changed; or active HCPCS code that is newly recognized as payable in ASC; or active HCPCS code that is discontinued at the end of the current calendar year. |
| NI | New code for the next calendar year or existing code with substantial revision to its code descriptor in the next calendar year, interim payment indicator assignment; comments will be accepted on the interim payment indicator for the new code. |
| NP | New code for the next calendar year or existing code with substantial revision to its code descriptor in the next calendar year as compared to current calendar year, proposed ASC payment indicator; comments will be accepted on the proposed ASC payment indicator for the new code. |
| NC | New code for the next calendar year or existing code with substantial revision to its code descriptor in the next calendar year as compared to current calendar year for which we requested comments in the proposed rule, final APC assignment; comments will not be accepted on the final APC assignment for the new code. |
Using the indicators on a claim
The indicator answers the first question a hospital outpatient line raises: will this line pay at all, and if so, from which schedule. A packaged line still belongs on the claim, because its charges feed the cost data CMS uses to set future APC rates. A status C line on an outpatient claim means the procedure is on the inpatient-only list, and an E1 line will deny as non-covered. Each HCPCS drug code page shows the code's October status and links to its row here; physician payment for the same service is a separate question answered by the physician fee schedule, and units and pair edits by the MUE lookup and NCCI checker, which use the hospital outpatient tables for facility claims.
Where QuickIntell fits with outpatient payment status
QuickRCM covers claim readiness, denials and A/R with configurable automation and human review, which is where a line's payment status, packaging and the expected APC payment are checked against what the remittance shows. Contract management compares expected reimbursement with allowed and paid amounts before a variance is pursued.
Frequently asked questions
What is an OPPS status indicator?
A one- or two-character payment status CMS assigns to every HCPCS code under the hospital outpatient prospective payment system. It says whether the line is paid separately through an APC, packaged into another service, paid under a different fee schedule, or not paid. The I/OCE 27.3.0 tables define 30 of them.
What does status indicator N mean?
N means the item or service is packaged: it is paid under OPPS, but its payment is included in the APC payment for the separately paid service on the same claim, so the line itself pays nothing extra.
What does status indicator J1 mean?
J1 marks a hospital Part B service paid through a comprehensive APC: one payment covers the primary procedure and most other services on the claim. The October 2026 Addendum A has 73 J1 APCs.
What is an ASC payment indicator?
The ambulatory surgical center equivalent of a status indicator, published in ASC Addendum DD1. Covered surgical procedures (Addendum AA) carry indicators such as A2, G2, J8 and P3, and covered ancillary services (Addendum BB) carry indicators such as N1, K2 and Z2; DD1 defines 22 of them.
More fee schedule references are on the Medicare fee schedules hub.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.
- Integrated Outpatient Code Editor v27.3 data tables: status and payment indicatorsVersion I/OCE v27.3 (October 2026) · effective 2026-10-01 · file Data_Status_Indicator.txtSHA-256 78f119ef0a435351…
- OPPS Addendum B, October 2026Version October 2026 · effective 2026-10-01 · file 508-compliant-version-2026_October_Web_Addendum_B.09.28.26.csvSHA-256 6ad7393a318bf1b9…
- OPPS Addendum A (APCs), October 2026Version October 2026 · effective 2026-10-01 · file 508-compliant-version-2026 October Web Addendum A.09.18.26.txtSHA-256 2a809862a8ec6096…
- ASC Addendum AA (covered surgical procedures), October 2026Version October 2026 · effective 2026-10-01 · file Oct 2026 ASC AA.txtSHA-256 bc3479589b7b1f23…
- ASC Addendum BB (covered ancillary services), October 2026Version October 2026 · effective 2026-10-01 · file Oct 2026 ASC BB.txtSHA-256 63cdd7c72aba7a25…
- ASC Addenda DD1 and DD2 (payment and comment indicators), CY2026Version October 2026 · effective 2026-10-01 · file Oct 2026 ASC DD1.txtSHA-256 b75c4b65cff86dd1…
Disclaimer
Operational reference compiled from CMS OPPS, ASC and I/OCE files obtained under the CMS click-through license. Indicator definitions are CMS text; counts are computed from the addenda without their descriptor columns. CPT and dental code descriptors are not reproduced. Not legal, coding or billing advice.
Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.