Procedure payment status
Source-defined status indicating whether a healthcare procedure is included and separately payable under a fee schedule.
Sources that carry it
3 sourcesCMS quarterly ASC Fee Schedule and Drug File addenda, publishing covered surgical procedures and ancillary services with HCPCS codes, payment indicators, discounting status, and payment rates. The July 2026 ZIP contains Addenda AA, BB, DD1, DD2, EE, and FF as XLSX and accessible CSV components and was updated July 13, 2026.
CMS quarterly OPPS Addenda A, B, and Q public files. CMS defines A and B as snapshots, effective at the beginning of each quarter, of HCPCS codes, status indicators, APC groups, and OPPS payment rates.
CMS's standing PFS reference product: downloadable annual and quarterly relative-value/locality files plus a web lookup accepting a single code, code range, or code list and returning Medicare payment information for national, MAC, or MAC-locality selections. The 2026 January release distinguishes QP and non-QP conversion-factor variants and publishes release-dated replacement ZIPs.
Questions it helps answer
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