Value Description
0 No payment adjustment
1 Paid standard amount for pass-through drug or biological (status indicator G)
2 Payment based on charge adjusted to cost (status indicator H)
3 Additional payment for new drug or new biological applies to APC (status indicator ‘J’)*
4 Deductible not applicable (specific list of HCPCS codes)
5 Blood/blood product used in blood deductible calculation
6 Blood processing/storage not subject to blood deductible
7 Item provided without cost to provider
8 Item provided with partial credit to provider
91-99 Each composite APC present, same value for prime and non-prime codes.
Flag 7 – Payment Method
Value Description
0 OPPS Pricer determines payment for service
1 Based on OPPS coverage, or billing rules, the service is not paid
2 Service is not subject to OPPS
