Updated research request forms and data security approval requirement effective 4/24/23
This variable indicates how the service listed on the revenue center record was priced for payment purposes.
The revenue center status indicator code is most useful with outpatient hospital claims, where multiple methods may be used to determine the payment amount for the various revenue center records on the claim (for example, some lines may be bundled into an APC and paid under the outpatient PPS, while other lines may be paid under other fee schedules).
This 2-byte indicator was added 10/2005 due to an expansion of a field that currently exist on the revenue center trailer. The status indicator is currently the 1st position of the Revenue Center Payment Method Indicator Code. The payment method indicator code is being split into two 2-byte fields (payment indicator and status indicator). The expanded payment indicator will continue to be stored in the existing payment method indicator field. The split of the current payment method indicator field is due to the expansion of both pieces of data from 1-byte to 2-bytes.
This field is populated for those claims that are required to process through outpatient PPS PRICER software. The type of bills (TOB) required to process through are: 12X, 13X, 14X (except Maryland providers, Indian Health Providers, hospitals located in American Samoa, Guam and Saipan and Critical Access Hospitals [CAH]); 76X; 75X and 34X if certain HCPCS are on the bill; and any outpatient type of bill with a condition code '07' and certain HCPCS. These claim types could have lines that are not required to price under OPPS rules so those lines would not have data in this field.
Additional exception: Virgin Island hospitals and hospitals that furnish only inpatient Part B services.
|Services not paid under OPPS; uses a different fee schedule (e.g., ambulance, PT, mammography)
|Non-allowed item or service for OPPS; may be paid under a different bill type (e.g., CORF)
|Inpatient procedure (not paid under OPPS)
|Non-allowed item or service (not paid by OPPS or any other Medicare payment system)
|Non-allowed item or service — not paid by Medicare when submitted on outpatient claims (any outpatient bill type)
|Non-allowed item or service for which pricing information and claims data is not available — not paid by Medicare when submitted on outpatient claims (any outpatient bill type)
|Corneal tissue acquisition, certain CRNA services and Hepatitis B vaccinations
|Drug/biological pass-through (separate APC includes this passthrough amount)
|Device pass-through (separate cost-based pass-through payment, not subject to coinsurance)
|New drug or new biological passthrough
|Primary service and all adjunctive services on the claim (comprehensive APC; effective 01/2015)
|Hospital Part B services that may be paid through a comprehensive APC — Paid under OPPS; Addendum B displays APC assignments when services are separately payable
|Non pass-through drug/biological, radio-pharmaceutical agent, certain brachytherapy sources (paid under OPPS; separate APC payment)
|Flu/PPV vaccines not paid under OPPS
|Service not billable to fiscal intermediary [now a MAC] (not paid under OPPS)
|Packaged incidental service (no separate APC payment)
|Paid partial hospitalization per diem APC payment
|Separate payment made; OPPS — APC (effective 2009)
|No separate payment made; OPPS — APC were packaged into payment for other services (effective 2009)
|May be paid through a composite APC-based on composite-specific criteria or separately through single code APCs when the criteria are not met (eff. 2009)
|Conditionally packaged laboratory tests Paid under OPPS or CLFS
|Blood products; Paid under OPPS; separate APC payment
|Significant procedure not subject to multiple procedure discounting
|Significant procedure subject to multiple procedure discounting
|Medical visit to clinic or emergency department
|Invalid HCPCS or invalid revenue code with blank HCPCS (terminated)
|Ancillary service (terminated)
|Non-implantable DME (e.g., therapeutic shoes; not paid under OPPS — bill to DMERC)
|Valid revenue with blank HCPCS and no other SI assigned (terminated)