All Entries Tagged With: "Status indicators"

CMS clarifies billing for devices and supplies

This week, CMS published an MLN Matters article related to the April update to the OPPS published in Transmittal 1702 to the Claims Processing Manual. CMS made two clarifications on billing devices and supplies that might be of interest to hospitals. [more]

Important CY 2009 OPPS status indicator changes

SIs “N,” “Q1,” Q2,” and “Q3”
In CY 2008, CMS greatly expanded the number of packaged items and services payable under the Outpatient Prospective Payment System (OPPS). More than 300 items and services that had formerly been separately payable became packaged, at least in certain circumstances. CMS is continuing this trend in CY 2009. Presently, there are four status indicators (SI) that identify packaged items and services: “N,” “Q1,” “Q2,” and “Q3.” Addendum D1 to the CY 2009 OPPS final rule defines SI “N” as identifying items and services that are paid under the OPPS; however, there is no separate payment for them. Instead, payment is included in the payment for other items and services. Think of those services as “never” being separately payable.

There are a number of other items and services that are “sometimes packaged” and “sometimes separately payable.”  In 2008, all of the “sometimes packaged” items and services were identified with the “Q” SI. These “Q” SI codes were then further divided into three subcategories, which established the criteria for determining whether they would be packaged or separately payable in particular circumstances. Those three subcategories were as follows: [more]