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This variable is contained in the following files: Home Health Agency (Fee-for-Service), Outpatient (Fee-for-Service)
Short SAS Name
PMTMTHD
SAS Name
REV_CNTR_PMT_MTHD_IND_CD

The code used to identify how the service is priced for payment.

This field is made up of two pieces of data, 1st position being the status indicator and the 2nd position being the payment indicator.

Comments

Prior to 10/2005, this variable contained the valid values for both the payment indicator and status indicator. Effective 10/2005, only the payment indicator codes remain in this table and the status indicator is housed in a new field named: REV_CNTR_STUS_IND_CD (with the corresponding values in the new table: REV_CNTR_STUS_IND_TB). Both the payment indicator and status indicator values have been expanded to 2-btyes.

This field is populated for those claims that are required to process through Outpatient PPS PRICER software. The type of bills (TOB) required to process through are: 12X, 13X, 14X (except Maryland providers, Indian Health Providers, hospitals located in American Samoa, Guam and Saipan and Critical Access Hospitals [CAH]); 76X; 75X and 34X if certain HCPCS are on the bill; and any outpatient type of bill with a condition code '07' and certain HCPCS. These claim types could have lines that are not required to price under OPPS rules so those lines would not have data in this field.

Additional exception: Virgin Island hospitals and hospitals that furnish only inpatient Part B services with dates of service 1/1/02 and forward.

Source: NCH

NOTE: Prior to 10/2005, this table contained the valid values for both the payment indicator and status indicator. Effective 10/2005, the payment indicator codes will remain in this table and the status indicator code values will be reflected in the new table: REV_CNTR_STUS_IND_TB. Both the payment indicator and status indicator values have been expanded to 2-btyes.
CodeCode value
1
Paid standard hospital OPPS amount (status indicators K, S,T,V,X)
2
Services not paid under OPPS (status indicator A, or no HCPCS code and not certain revenue center codes)
3
Not paid (status indicator M,W,Y,E) or not paid under OPPS (status indicator B,C & Z)
4
Paid at reasonable cost (status indicator F,L)
5
Additional payment for drug or biological (status indicator G)
6
Additional payment for device (status indicator H)
7
Additional payment for new drug or new biological (status indicator J)
8
Paid partial hospitalization per diem (status indicator P)
9
No additional payment, payment included in line items with APCs (status indicator N, or no HCPCS code and certain revenue center codes, or HCPCS codes G0176 (activity therapy), G0129 (occupational therapy) or G0177 (partial hospitalization program services)
*********VALUES PRIOR TO 10/3/2005************** **********Service Indicator************** ********** 1st position *****************
CodeCode value
A
Services not paid under OPPS
C
Inpatient procedure
E
Noncovered items or services
F
Corneal tissue acquistion
G
Current drug or biological pass-through
H
Device pass-through
J
New drug or new biological pass-through
N
Packaged incidental service
P
Partial hospitalization services
S
Significant procedure not subject to multiple procedure discounting
T
Significant procedure subject to multiple procedure discounting
V
Medical visit to clinic or emergency department
X
Ancillary service
**********Payment Indicator************** ********** 2nd position *****************
CodeCode value
1
Paid standard hospital OPPS amount (service indicators S,T,V,X)
2
Services not paid under OPPS (service indicator A, or no HCPCS code and not certain revenue center codes)
3
Not paid (service indicators C & E)
4
Acquisition cost paid (service indicator F)
5
Additional payment for current drug or biological (service indicator G)
6
Additional payment for device (service indicator H)
7
Additional payment for new drug or new biological (service indicator J)
8
Paid partial hospitalization per diem (service indicator P)
9
No additional payment, payment included in line items with APCs (service indicator N, or no HCPCS code and certain revenue center codes, or HCPCS codes Q0082 (activity therapy), G0129 (occupational therapy) or G0172 (partial hospitalization training)