Wiki Complete List of all Status Indicators

[tashbelle4]

Hi,
Where can I find an Excel spreadsheet of all status code indicators for all CPT and HPCS codes? For example, on the National Physician Fee Schedule Relative Value File January Release file, J7320 has an E status code but it is also a contractor discretion code so "C" should also be present.

 

[thomas7331]

There is no status indicator C for this code because drugs are never priced on the MPFS. Rather, as status code E indicates, payment for drugs, "when covered, generally continues under reasonable charge procedures". So to find drug prices, you'd need to look at the average sales price files, which you can find here: https://www.cms.gov/medicare/medicare-fee-for-service-part-b-drugs/mcrpartbdrugavgsalesprice

J7320 does not appear on the ASP file, but you'll notice a 'Note 2' at the top which states: "The absence or presence of a HCPCS code and the payment allowance limits in this table does not indicate whether Medicare covers a drug. These determinations shall be made by the local Medicare contractor processing the claim." This is what drives the pricing of this code, not the MPFS status indicator.

 

[tashbelle4]

This is great info. I'll have to do some cross referencing. When I look at EncoderPro, I see that there is a contractor discretion status present and thought J7320 had two status code indicators.

 

[rachaelwilleford]

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/downloads/CMS-1404-P_AddD1.pdf

What place of service is it being billed? Encoder shows that the in outpatient facility, it has a payment status indicator of K2. Would be different for office.