OPPS payment status indicator · CMS Addendum D1
Status indicator S: paid separately, not discounted when multiple.
Status indicator S is CMS's label for a procedure or service that is not discounted when multiple, paid under OPPS with a separate APC payment. Many references call it "significant procedure"; the CY 2026 Addendum D1 does not use that phrase. An S service packages Q1 codes on the same claim.
Look up a code
Result
Enter a code, then press Look up.
What CMS says status indicator S means
Procedure or Service, Not Discounted When Multiple
CMS's OPPS payment status for S is "Paid under OPPS; separate APC payment." (CY 2026 Addendum D1).
Correction to the common wording
A common description of S is "significant procedure, not discounted when multiple". The CY 2026 Addendum D1 text reads "Procedure or Service, Not Discounted When Multiple", so this page uses CMS's words. The CY 2026 Addendum D1 also lists S1, "Skin substitute product paid separately", with payment based on the product's FDA regulatory pathway.
What S does to other codes
| Code | What CMS says |
|---|---|
| Q1 (STV-packaged) | Packaged APC payment if billed on the same claim as a code with status indicator S, T or V. |
| Q4 (lab test) | Packaged APC payment if billed with a published status indicator J1, J2, S, T, V, Q1, Q2 or Q3. |
| Q2 (T-packaged) | Not affected by S. Q2 is packaged only when a T service is on the claim. |
S compared with T
Both are paid separately. The label that differs is the reduction: T is subject to the multiple procedure reduction (see the T page) and S is labeled not discounted when multiple. The Medicare manual's discount rule (chapter 4, section 10.5) refers to multiple surgical procedures in the same session; which indicator a code carries is set per code in Addendum B.
What to check
- Look up the code in Addendum B for the date of service and confirm the indicator is S.
- If a Q1 line shows no payment, check whether an S line is the reason.
- S is not in the manual's observation condition for G0379, which names T and V; do not assume S behaves the same way.
Worked example (hypothetical)
A claim has an S procedure and a Q1 code. The S procedure is paid through its APC. The Q1 code is packaged into it, so its line shows no separate payment even though the code is also payable on its own on other claims.
Other codes in this set
Indicators Q1-Q4, Indicator A, Indicator N, Indicator K, Indicator G, Indicator J1, Indicator T, 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
Is S the same as significant procedure?
The common shorthand says so, but the CY 2026 Addendum D1 labels S "Procedure or Service, Not Discounted When Multiple".
Does S get the multiple procedure reduction?
CMS labels S as not discounted when multiple. T is the indicator labeled as subject to the multiple procedure reduction.
Does an S service package other codes?
Yes. A Q1 (STV-packaged) code on the same claim is packaged into the payment for the S service.
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.