APC indicator codes


Best answers
Do you know how often and when APC indicator codes are added? I know we get APC updates every quarter but I'm unsure how often the indicators change. Thank you.

A Pd under other Sch/Pmt System

B Not recognized on OP bill

C IP Procedure

D Deleted Code

E Not Paid by Medicare

F Not Paid by OPPS. Cost

G Drug/Biological Separate APC w/pass through

H Device Separate Cost Based on Pass through

K Drug/Biological Separate APC non-pass through

L Vaccine not paid under OOPS

N Items/Services packaged into APC

P Partial Hospitalization

S Significant Procedure Multi not discounted

T Significant Procedure Multi reduction applies

V Clinic/Emergency Visit

Y Non-implant Durable Med Equipm

X Ancillary Services

M Items and srvcs not billable to Fiscal Intrmed

W Invalid or blank HCPCS and invalid rev code

Z Valid RevCode, blank HCPCS, no other Stat Ind


True Blue
Columbia, MO
Best answers
These do not change that often really, you get updates every quarter for APCs but these do not change every quarter, most of these have been in place since 2000. Every CPT code is assigned a status indicator, they tell us how these codes are processed or viewed byt the payer, such as all visit level codes have a V, and x-rays are an X, and CT scans are an S. Addendum B of the federal register has the list of all CPT codes and their corresponding status indicator. I hope this answers your question.