OPPS payment status indicator · CMS Addendum D1
Status indicator T: paid separately, with a multiple procedure reduction.
Status indicator T marks a procedure or service paid separately under OPPS where the multiple procedure reduction applies. When two or more T services are billed on the same date of service, the manual says a reduced payment applies to the lower-weighted ones. A T service also packages any Q2 (T-packaged) codes on the claim.
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What CMS says status indicator T means
Procedure or Service, Multiple Procedure Reduction Applies
CMS's OPPS payment status for T is "Paid under OPPS; separate APC payment." (CY 2026 Addendum D1). The CY 2026 final rule quotes the same definition in a footnote.
How the reduction works in the Medicare manual
Chapter 4, section 10.1.1 says services with status indicator T are paid separately under OPPS but a multiple procedure payment reduction applies when two or more services with status indicator T are billed on the same date of service. Section 10.5 (Discounting) says that when multiple surgical procedures are furnished during the same operative session, the full amount is paid for the surgical procedure with the highest weight and fifty percent is paid for any other surgical procedure performed at the same time. It adds that beneficiary coinsurance is discounted in proportion to the APC payment.
CMS describes the reduction in terms of surgical procedures in the same operative session. Whether a specific pair of T codes on your claim is reduced is determined by the claims processing system, not by this page.
What T does to other codes
- Q2 codes are T-packaged: they are packaged when a T service is on the same claim (section 10.4).
- Q1 codes are packaged when an S, T or V service is on the claim.
- Q4 lab tests are packaged with a T service among others.
T versus S
S and T are both paid separately. The difference in CMS's own labels is that S is "Not Discounted When Multiple" and T is "Multiple Procedure Reduction Applies".
Worked example (hypothetical)
Two T procedures are performed in one operative session. Under the manual's rule, the procedure with the higher weight is paid at the full APC amount and the other at fifty percent. The patient's coinsurance on the second procedure is discounted in proportion. If the claim also carried a Q2 code, it would show no separate payment.
Other codes in this set
Indicators Q1-Q4, Indicator A, Indicator N, Indicator K, Indicator G, Indicator J1, 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.
Frequently asked questions
Does T mean the service is packaged?
No. CMS lists T as paid under OPPS with a separate APC payment. The multiple procedure reduction can lower the second and later T procedures.
What is the reduction?
The Medicare manual says the full amount is paid for the highest-weighted surgical procedure and fifty percent for any other surgical procedure performed at the same time.
Does T package other codes?
Yes. A Q2 (T-packaged) code on the same claim is packaged into the payment for the T 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.