Status indicator J1: one comprehensive APC payment.

What CMS says status indicator J1 means

Hospital Part B Services Paid Through a Comprehensive APC

CMS's OPPS payment status for J1: "Paid under OPPS; all covered Part B services on the claim are packaged with the primary "J1" service for the claim, except the Comprehensive APC payment policy exclusions found in the most recent Addendum J." (CY 2026 Addendum D1). The CY 2026 final rule repeats the definition in a footnote: status indicator J1 denotes hospital Part B services paid through a comprehensive APC.

J2 in one line

Addendum D1 defines J2 as "Hospital Part B Services That May Be Paid Through a Comprehensive APC". It is paid through a comprehensive APC for specific combinations of services, is packaged if billed with a J1 service, and in other circumstances is separately paid or packaged. The CY 2026 final rule ties J2 to the Comprehensive Observation Services C-APC (APC 8011).

What the Medicare manual says is excluded from packaging

Chapter 4, section 10.2.3 lists services excluded from comprehensive APC packaging, including:

• ambulance services
• brachytherapy sources (status indicator U)
• pass-through drugs, biologicals and devices (status indicators G or H)
• preventive services defined in 42 CFR 410.2
• self-administered drugs that do not function as supplies in the comprehensive service
• services assigned to status indicator F or L
• services assigned to a New Technology APC
• drugs or biologicals reported with HCPCS code C9399

Section 10.2.3 gives the full list, and the CMS Addendum J file is the authority for the current year. Section 10.2.4 adds that non-therapy outpatient services similar to therapy that are adjunctive to a J1 service can be reported with revenue code 0940 or with the appropriate occurrence codes, CPT codes, modifiers and revenue codes.

What to check

1. Find the J1 line first. Its payment covers most other lines on the claim.
2. Compare other lines against the exclusion list above. Excluded lines are paid on their own indicator.
3. Do not split one encounter across claims to avoid packaging; the packaging works at the claim level.

Worked example (hypothetical)

A claim has a J1 surgical procedure, several N supplies, an imaging study and a G pass-through drug. The J1 payment covers the procedure and the packaged lines. The G drug is on the manual's exclusion list and is paid separately. The remittance therefore shows one large payment and one separate drug payment, not a payment per line.

Other codes in this set

Indicators Q1-Q4, Indicator A, Indicator N, Indicator K, Indicator G, 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
• Federal Register: CY 2026 OPPS/ASC final rule, 90 FR 53448 (published 2025-11-25) — footnotes defining status indicators J1, J2 and T (retrieved 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.