Medicare Physician Fee Schedule Indicators

by  Brittney Murdock, QCC, CMCS, CPC
March 4th, 2019

Many denials can be avoided when you understand how a payer looks at a code. Find-A-Code puts a lot of this information all on one page. Under Additional Code Information on CPT codes, you will find a lot of questions can be answered.

In addition to the global policy, uniform payment policies and claims processing requirements have been established for other surgical issues, including bilateral and multiple surgeries, co-surgeons, and team surgeons. This is all found on the Additional Code Information page.

For example, look at the following CPT code and the indicators telling how this code is used.

28445 - Open treatment of talus fracture, includes internal fixation, when performed

The first indicator is J1. If you hover over the ICON, the description of it will show how it is used and where it can be used.

We can see this is payable under OPPS, Hospital Part B through a comprehensive APC. This also tells us this is a packaged code and everything for this procedure is bundled with the exception of services with OPPS SI=F,G, H, L and U; ambulance services; diagnostic and screening mammography; all preventive services; and certain Part B inpatient services.