OPPS payment status indicator · CMS Addendum D1
Status indicator V: clinic or emergency department visit.
Status indicator V marks a clinic or emergency department visit, paid under OPPS with a separate APC payment. A V service on the claim packages Q1 codes and certain Q4 lab tests. The manual's criteria for payment of direct referral to observation (HCPCS G0379) also look at whether a T or V service was provided the same day.
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What CMS says status indicator V means
Clinic or Emergency Department Visit
CMS's OPPS payment status for V is "Paid under OPPS; separate APC payment." (CY 2026 Addendum D1).
What a V line does to other lines
| 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 V; packaged only with a T service. |
Chapter 4, section 10.4 states the same STV rule for Q1: an STV-packaged service is paid separately only if no S, T or V service is on the claim.
V and observation
Chapter 4 of the Medicare Claims Processing Manual sets criteria for payment of HCPCS code G0379 (direct referral for hospital observation care): among them, no service with status indicator T or V, or critical care, is provided on the same day of service as G0379. If the criteria are not met, the manual says G0379 is assigned status indicator N and packaged into payment for other separately payable services in the same encounter. That is one way a V visit on the same day can change how observation is paid. Read the current observation section of chapter 4 for the full conditions.
What to check
- Confirm the visit code carries V in Addendum B for the date of service.
- If a Q1 line shows no payment, a V line is one possible reason.
- On a claim with direct referral to observation (G0379), check the T and V condition before assuming the payment path.
Worked example (hypothetical)
An emergency visit code carries V and the claim also contains a Q1 code. The visit is paid through its APC. The Q1 code is packaged into the visit payment and shows no separate payment, because a V service is on the same claim.
Other codes in this set
Indicators Q1-Q4, Indicator A, Indicator N, Indicator K, Indicator G, Indicator J1, Indicator T, Indicator S, Indicators E1 and E2.
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 V paid separately?
Yes. CMS lists V as paid under OPPS with a separate APC payment.
What does a V visit package?
A Q1 (STV-packaged) code on the same claim is packaged into the payment for the V service, and certain Q4 lab tests are too.
Why does V matter for observation?
The Medicare manual's criteria for paying HCPCS G0379 (direct referral to observation) require that no service with status indicator T or V was provided the same day, so a V visit can change how it is paid.
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.