OPPS payment status indicator · CMS Addendum D1
Status indicator G: pass-through drugs and biologicals.
Status indicator G marks drugs and biologicals with OPPS transitional pass-through status, which are paid under OPPS with a separate APC payment. Pass-through devices use H. Pass-through items are excluded from comprehensive APC packaging.
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What CMS says status indicator G means
Pass-Through Drugs and Biologicals
CMS's OPPS payment status for G is "Paid under OPPS; separate APC payment." (CY 2026 Addendum D1).
G, H and K side by side
| Indicator | CMS item/code/service | OPPS payment status |
|---|---|---|
| G | Pass-Through Drugs and Biologicals | Paid under OPPS; separate APC payment. |
| H | Pass-Through Device Categories | Separate cost-based pass-through payment; not subject to copayment. |
| K | Nonpass-Through Drugs and Nonimplantable Biologicals, Including Radiopharmaceuticals | Paid under OPPS; separate APC payment. |
Why G matters with comprehensive APCs
Chapter 4, section 10.2.3 of the Medicare Claims Processing Manual lists the services excluded from comprehensive APC packaging. One entry reads: pass-through drugs, biologicals and devices (status indicators G or H). So a G drug on the same claim as a J1 primary service is not folded into the J1 payment on that basis.
What to check
- Confirm G in Addendum B for the date of service. CMS assigns indicators code by code each period, so the indicator can change.
- If the claim also has a J1 service, the G exclusion above applies to the drug.
- If the line shows no separate payment, compare the code's indicator on the date of service rather than on today's file.
Worked example (hypothetical)
A hospital bills a comprehensive-APC procedure (J1) and a new drug with a G indicator. The J1 service packages most other lines, but the manual's exclusion for G and H items means the drug is not packaged into it for that reason, and it is priced separately.
Other codes in this set
Indicators Q1-Q4, Indicator A, Indicator N, Indicator K, Indicator J1, Indicator T, Indicator S, Indicators E1 and E2, Indicator V.
Sources
- CMS: CY 2026 OPPS/ASC final rule (CMS-1834-FC), Addendum D1, OPPS Payment Status Indicators for CY 2026 — status indicator definitions and payment status (addenda file dated 11.20.2025, retrieved 2026-11-02)
- CMS: Medicare Claims Processing Manual, Chapter 4 (Part B Hospital, including OPPS), Rev. 13799, issued 05-28-26 — read 2026-11-02
The Addendum D1 text and Medicare manual passages above were read on November 2, 2026. The Addendum D1 wording below is CMS's own text for the CY 2026 OPPS (file dated 11.20.2025). CMS republishes Addendum D1 every year, so the indicator on a claim for another year should be checked against that year's file. Causes, checks and examples are general billing practice written for this page, not CMS content. Payers and CMS revise code lists, contracts and policies, so confirm anything that affects a claim or a payment with your Medicare Administrative Contractor.
Frequently asked questions
What is the difference between G and K?
G is for pass-through drugs and biologicals. K is for non-pass-through drugs and non-implantable biologicals. Both are paid with a separate APC payment.
Are G drugs packaged into comprehensive APCs?
The Medicare manual lists pass-through drugs, biologicals and devices (status indicators G or H) among the exclusions from comprehensive APC packaging.
Why check the date of service?
Status indicators are assigned code by code in Addendum B, so the indicator on the date of service is the one that governs the claim.
Not legal, billing or medical advice
This page explains published CMS code definitions and runs a lookup in your browser. It cannot see your claim, your contract or any payer's policy. Confirm with your Medicare Administrative Contractor before you resubmit, appeal or bill a patient.