Coding Guidelines: Institutional Billing Resources for Addendums A, B, D1, E

Published 09/25/2024

The Hospital Outpatient Prospective Payment System (OPPS) is updated quarterly. Each update can outline outpatient HCPCS codes, status indicators, APC groups, and OPPS payment rates. The resources below will assist you in obtaining coding guidelines for Institutional billing to Medicare. 

Addendum A — APC Groups and OPPS Payment Rates

  • After clicking on the hyperlink above, choose the appropriate release date from the options listed
  • Then on the "Details for title: Month 20XX" page, click on Addendum A under "Related Links"
  • After you choose Accept and open, a box will appear with all the addenda available
  • Choose either version of Addendum A (.xlsx or .csv) and the file will open

Addendum B — HCPCS Codes and their Status Indicators

  • After clicking on the hyperlink above, choose the appropriate release date from the options listed
  • Then on the "Details for title: Month 20XX" page, click on Addendum B under "Related Links"
  • After you choose Accept and open, a box will appear with all the addenda available
  • Choose either version of "Addendum B" (.xlsx or .csv) and the file will open

Addendum D1 — Payment Status Indicators for the Hospital Outpatient Prospective Payment System

  • After clicking on the hyperlink above, choose the regulation number for the appropriate "Final Rulemaking" year requested, CMS-xxxx-FC
  • Scroll to the bottom of the page. Under related links choose "20XX NFRM OPPS Addenda" from the options listed.
  • After you choose Accept and open, a box will appear with all the addenda available
  • Choose either version of "20XX NFRM Addendum D1" (.xlsx or .tst) and the file will open

Addendum E — Inpatient Only Procedure Codes

  • After clicking on the hyperlink above, choose the regulation number for the appropriate "Final Rulemaking" year requested, CMS-xxxx-FC
  • Choose "20XX NFRM OPPS Addenda" from the options listed
  • After you choose Accept and open, a box will appear with all the addenda available
  • Choose either version of "20XX NFRM Addendum E" (.xlsx or .csv) and the file will open

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