### ADDENDUM D1.

— PROPOSED OPPS PAYMENT STAT U S INDICATORS FOR CY 201 2

ADDENDUM D1.

— PROPOSED OPPS PAYMENT STATUS INDICATORS FOR CY 201 2

Indicator Item/Code/Service OPPS Payment Status

A Services furnished to a hospital outpatient that are paid under a fee sc hedule or payment system other than OPPS, for example: Not paid under OPPS. Paid by fiscal intermediaries/MACs under a fee schedule or payment system other than OPPS.
Services are subject to deductible and coinsurance unless indicated otherwise.

**•** Ambu lance Services

**•** Clinical Diagnostic Laboratory Services Not subject to deductible or coinsurance.

**•** Non

- Implantable Prosthetic and Orthotic Devices

**•** EPO for ESRD Patients

**•** Physical, Occupational, and Speech Therapy

**•** Routine Dialysis Services for ESRD Patients Provided in a Certified Dialysis Unit of a Hospital

**•** Diagnostic Mammography

**•** Screening Mammography Not subject to deductible or coinsurance

.ADDENDUM D1.

— PROPOSED OPPS PAYMENT STATUS INDICATORS FOR CY 201 2

Indicator Item/Code/Service OPPS Payment Status

B Codes that are not recognized by OPPS when submitted on an outpatient hospital Part B bill t ype (12x and 13x). Not paid under OPPS.
● May be paid by fiscal intermediaries/MACs when submitted on a different bill type, for example, 75x (CORF), but not paid under OPPS.
● An alternate code that is recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x and 13x) may be available.

C Inpatient Procedures Not paid under OPPS. Admit patient. Bill as inpatient.

D Discontinued Codes Not paid under OPPS or any other Medicare payment system.

E Items, Codes, and Services:

● Th at are not covered by any Medicare outpatient benefit based on statutory exclusion.
● That are not covered by any Medicare outpatient benefit for reasons other than statutory exclusion.
● That are not recognized by Medicare for outpatient claims but for which an alternate code for the same item or service may be available.
● For which separate payment is not provided on outpatient claims. Not paid by Medicare when submitted on outpatient claims (any outpatient bill type).

F Corneal Tissue Acquisition; Certain CRNA Services and Hepatitis B Vaccines Not paid under OPPS. Paid at reasonable
cost.ADDENDUM D1.

— PROPOSED OPPS PAYMENT STATUS INDICATORS FOR CY 201 2

Indicator Item/Code/Service OPPS Payment Status

G Pass

- Through Drugs and Biologicals Paid under OPPS; separate APC payment.

H Pass

- Through Device Categories Separate cost

- based pass

- through payment; not sub ject to copayment.

K Nonpass

- Through Drugs and Nonimplantable Biologicals, Including Therapeutic Radiopharmaceuticals Paid under OPPS; separate APC payment.

L Influenza Vaccine; Pneumococcal Pneumonia Vaccine Not paid under OPPS. Paid at reasonable
cost ; not subject to deductible or coinsurance.

M Items and Services Not Billable to the Fiscal Intermediary/MAC Not paid under OPPS.

N Items and Services Packaged into APC Rates Paid under OPPS; payment is packaged into payment for other services. Therefor e, there is no separate APC payment.

P Partial Hospitalization Paid under OPPS; per diem APC payment.
Q1 STVX

- Packaged Codes Paid under OPPS; Addendum B displays APC assignments when services are separately payable.
(1) Packaged APC payment if billed o n the same date of service as a HCPCS code assigned status indicator “S,” “T,” “V,” or “X.”
(2) In all other circumstances, payment is made through a separate APC payment.ADDENDUM D1.

— PROPOSED OPPS PAYMENT STATUS INDICATORS FOR CY 201 2

Indicator Item/Code/Service OPPS Payment Status
Q2 T

- Packaged Codes Paid under OPPS; Addendum B displays APC assignments when ser vices are separately payable.
(1) Packaged APC payment if billed on the same date of service as a HCPCS code assigned status indicator “T.”
(2) In all other circumstances, payment is made through a separate APC payment.
Q3 Codes That May Be Paid Through a Composite APC Paid under OPPS; Addendum B displays APC assignments when services are separately payable.
Addendum M displays composite APC assignments when codes are paid through a composite APC.
(1) Composite APC payment based on OPPS composite

- speci fic payment criteria. Payment is packaged into a single payment for specific combinations of service s

. (2) In all other circumstances, payment is made through a separate APC payment or packaged into payment for other services.

R Blood and Blood Products Paid under OPPS; separate APC payment.

S Significant Procedure, Not Discounted When Multiple Paid under OPPS; separate APC payment.

T Significant Procedure, Multiple Reduction Applies Paid under OPPS; separate APC payment.

U B rachytherapy Sources Paid under OPPS; separate APC payment.ADDENDUM D1.

— PROPOSED OPPS PAYMENT STATUS INDICATORS FOR CY 201 2

Indicator Item/Code/Service OPPS Payment Status

V Clinic or Emergency Department Visit Paid under OPPS; separate APC payment.

X Ancillary Services Paid under OPPS; separate APC payment.

Y Non

- Implantable Durable Medical Equipment Not paid u nder OPPS. All institutional providers other than home health agencies bill to DMERC.