Wiki Help for Status Indicator N for OPPS please?

[steff14038@aol.com]

The manual reads: item/service packaged into APC rate. I have a note to myself that it is paid under OPPS and the payment is packaged into the payment with other services, no separate APC payment. I'm trying to determine if my PACE Program would cover J3304-Triamcinolone acetonide xr 32 mg injections to bilateral knees. My search of my local MAC does not price this code and the Medicare FFS schedule does not have a fee. I find the code on the Medicare January 2023 ASP pricing file, but this does not guarantee coverage. I need to determine if my PACE Program can separately pay the Ortho docs for the injection or tell them it is not separately billable. Thank you.

 

[sls314]

The manual reads: item/service packaged into APC rate. I have a note to myself that it is paid under OPPS and the payment is packaged into the payment with other services, no separate APC payment. I'm trying to determine if my PACE Program would cover J3304-Triamcinolone acetonide xr 32 mg injections to bilateral knees. My search of my local MAC does not price this code and the Medicare FFS schedule does not have a fee. I find the code on the Medicare January 2023 ASP pricing file, but this does not guarantee coverage. I need to determine if my PACE Program can separately pay the Ortho docs for the injection or tell them it is not separately billable. Thank you.

In OPPS, the N status indicator means that reimbursement is packaged into the APC payment rate for the procedure. No additional payment is made for any items with a Status N indicator.

The cost was already taken into consideration and bundled into the overall APC reimbursement rate.

 

[steff14038@aol.com]

Thank you so very much for your answer! The help is greatly appreciated.