Certified Inpatient Coding (CIC) Practice Exam

Under OPPS, if a HCPCS code has a status indicator "G," what does it indicate about the device payment?

1. Paid as a percentage of charges

2. Paid an APC-based fee

3. Not eligible for reimbursement

4. Payment is zero

The correct answer is: Paid an APC-based fee

A status indicator "G" under the Outpatient Prospective Payment System (OPPS) signifies that the device payment is classified as an "appliance or device" that is eligible for a separate payment when billed with the corresponding procedure. Specifically, this means that the device is reimbursed through an Ambulatory Payment Classification (APC)-based fee. This classification allows for direct compensation for the use of certain devices in outpatient settings, given their role in the patient's treatment. The APC system is designed to bundle related items and services together, whereby the specific device-related services may be recognized as significant enough to warrant their individual billing and subsequent payment. In contrast, other status indicators convey different payment approaches, such as percentage-based payments, ineligible reimbursements, or instances when payment is not made at all. Understanding how these classifications work aids in accurate coding and ensures that appropriate reimbursements are achieved for necessary medical devices in outpatient settings.