Glossary · Updated Aug 11, 2026
PFS Status Indicators
A status indicator is a single-letter code that tells you how Medicare treats a service under the Physician Fee Schedule—whether it is separately payable, bundled into another service, carrier-priced, or not covered. The status decides payability and usually points you to the applicable payment path; it should not be inferred from whether the RVU fields are blank or zero. Eight of the twelve letters mean "no payment under the PFS," but they mean it for reasons different enough that the next step changes: some of those services Medicare pays for in full under another fee schedule.
Payable statuses Copy link
Status A (active) codes are separately payable and have a national payment amount. Status R (restricted) codes are payable under specific coverage conditions. Status T codes are payable only when no other Physician Fee Schedule service is billed on the same day. These are the statuses for which a national amount is calculated.
Carrier-priced Copy link
Status C means the code is carrier-priced: there is no national payment amount, and the local Medicare Administrative Contractor sets the price. A rate engine should report that a national amount is unavailable rather than invent a figure.
Anesthesia (status J) Copy link
Status J codes are anesthesia services, priced under a separate formula—base units plus time units, multiplied by an anesthesia conversion factor and a locality adjuster—rather than the RVU-based PFS formula. A rate lookup for a status J code with a locality returns the anesthesia conversion factor for that locality instead of an RVU-based amount.
No PFS payment is not the same as not covered Copy link
This is the distinction that causes the most confusion, because a blank payment column looks identical in all eight cases. Statuses X and E describe services Medicare genuinely covers and pays for—just not from this fee schedule. CMS defines X as an item or service that falls outside the statutory definition of "physician services," and gives ambulance services and clinical diagnostic laboratory tests as its own examples. A status X lab test is not uncovered; it is priced under the Clinical Laboratory Fee Schedule, and a claim for it is paid. Statuses B and P mean payment exists but is folded into another service rather than made separately. Status I means Medicare pays for the service, under a different code. Status M is a measurement code used for reporting. Only status N means Medicare covers no part of the service at all.
Status N, the only letter that settles coverage Copy link
CMS is explicit that the status field is a payment field rather than a coverage field, with one exception: "The nature of the status indicator in the database does not control coverage except where the status is N for noncovered." So N is the one letter you can read as a coverage answer. What N does not tell you is why the service is not covered—and that reason, not the letter, determines whether you file a claim, whether an Advance Beneficiary Notice is required, and whether you may bill the patient. Non-covered codes fall into at least three legally distinct groups:
| Why it is not covered | Examples | What it usually means for billing |
|---|---|---|
| Excluded by statute | Routine physicals (99381–99397), hearing aids, eyeglass fitting | Never covered, by law. An ABN is not required, though CMS encourages issuing one voluntarily as a courtesy. |
| Ruled out by a national or local coverage determination as not reasonable and necessary | Services an NCD or LCD specifically excludes | Coverage was decided by policy rather than statute, so a mandatory ABN generally applies. |
| New or experimental | Category III codes tracking emerging services | A mandatory ABN generally applies. |
Working out which group a non-covered code is in Copy link
Nothing in the CMS release files records the reason, so the status letter alone cannot tell you—two codes both marked N can carry opposite billing obligations. Treat N as the start of the question rather than the answer: check whether the service is named in the statutory exclusions at 42 U.S.C. §1395y(a), and if it is not, look for a national or local coverage determination covering it. Guidance that reads "status N, so bill the patient" is wrong often enough to be worth distrusting.
Status indicators at a glance Copy link
Every status letter above, in one table:
| Status | Meaning | Separately payable? |
|---|---|---|
| A | Active—separately payable with a national amount | Yes |
| R | Restricted—payable under specific coverage conditions | Yes |
| T | Payable only when no other PFS service is billed the same day | Yes |
| C | Carrier-priced—the local MAC sets the price | No national amount |
| J | Anesthesia—priced by the separate anesthesia formula | Via anesthesia formula |
| B | Bundled into payment for another service | No |
| I | Not valid for Medicare—another code is used instead | No |
| N | Non-covered—Medicare covers no part of the service | No |
| P | Bundled or excluded | No |
| M | Measurement code, used for reporting | No |
| X | Outside the statutory definition of "physician services"—covered, but paid under another fee schedule | Not under the PFS |
| E | Excluded from the PFS by regulation | Not under the PFS |
Frequently asked Copy link
Which status codes are payable?
A, R, and T are separately payable and have a national amount. C is carrier-priced (no national amount). J (anesthesia) is priced under a separate formula, not the RVU-based PFS formula. B, I, N, P, M, X, and E are not separately payable under the PFS—though X and E services are frequently paid in full under a different fee schedule.
A code has RVUs but is not paying—why?
Payability follows the status indicator, not the presence of RVUs. CMS publishes RVU values for some codes that are not payable, so a non-payable status will not produce a payment even though RVUs exist.
What is the difference between status N and status X?
Status X services are covered by Medicare and paid under a different fee schedule—CMS names ambulance services and clinical diagnostic laboratory tests as its examples. Status N services are not covered at all. A lab test marked X will be paid from the Clinical Laboratory Fee Schedule; a service marked N will not be paid from anywhere.
What is the difference between status N and status B?
Status B means Medicare does pay for the service, but the payment is bundled into another service billed alongside it rather than made separately. Status N means Medicare covers no part of the service. Describing an N code as "not separately payable" understates it—there is no payment to separate.
Can I bill the patient for a status N code?
It depends on why the code is non-covered, which the status letter does not record. For services excluded from Medicare by statute, such as routine physicals, the patient is liable and no Advance Beneficiary Notice is required, though CMS encourages issuing one voluntarily. For services ruled out by a national or local coverage determination as not reasonable and necessary, a mandatory ABN generally applies and billing the patient without one is not permitted. Check which situation applies before billing.
Why does a code have a status indicator but no payment amount?
Eight of the twelve status letters carry no PFS payment amount, for different reasons: the service is bundled (B, P), billed under another code (I), used only for reporting (M), paid under a different fee schedule (X, E), priced locally by your contractor (C), or not covered (N). A blank amount is not a zero-dollar rate, and it does not by itself mean the service is uncovered.
Sources Copy link
- CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field)
- CMS Physician Fee Schedule overview (cms.gov)
- CMS Medicare Claims Processing Manual (Pub. 100-04)
Written from primary CMS sources—see how we source, compute, and verify everything on this site.
- The status indicator is a payment field rather than a coverage field, with one exception: CMS states that "the nature of the status indicator in the database does not control coverage except where the status is N for noncovered." —CMS Medicare Claims Processing Manual (Pub. 100-04)
- CMS defines status N as a non-covered service: "These codes are carried on the HCPCS tape as noncovered services." —CMS Medicare Claims Processing Manual (Pub. 100-04)
- Status X marks an item or service that is not in the statutory definition of "physician services" for fee schedule payment purposes. CMS gives ambulance services and clinical diagnostic laboratory services as its examples, both of which Medicare covers and pays under other fee schedules. —CMS Medicare Claims Processing Manual (Pub. 100-04)
- Status B means payment for a covered service is always bundled into payment for another service, and no separate payment is ever made; CMS gives a hospital nurse telephone call about a patient as an example. —CMS Medicare Claims Processing Manual (Pub. 100-04)
- Status I means the code is not valid for Medicare purposes because Medicare uses another code for reporting of, and payment for, the service. —CMS Medicare Claims Processing Manual (Pub. 100-04)
- CMS states that a preventive medicine service billed with CPT codes 99381-99397 is a noncovered service, and separately instructs providers not to bill annual wellness visit services using those codes. —CMS Medicare Claims Processing Manual (Pub. 100-04)
- Routine physical checkups are excluded from Medicare coverage by statute, subject to carve-outs that include the initial preventive physical examination and personalized prevention plan services. —42 USC 1395y(a)(15) (SSA §1862(a)(15))—exclusion of assistant-at-surgery services
- An Advance Beneficiary Notice is not required for care that is statutorily excluded from Medicare coverage, though CMS strongly encourages issuing one as a courtesy; when used this way the beneficiary should not be asked to choose an option box or sign the notice. —CMS Medicare Claims Processing Manual (Pub. 100-04)
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