Medicare Claims Processing Manual (Pub. 100-04), Ch. 4 § 40.1.1
Patient Status Code and Reason for Patient Visit for the
40.1.1 - Patient Status Code and Reason for Patient Visit for the
Hospital OPPS
(Rev. 243, Issued 07-23-04, Effective: January 1, 2005/Implementation: January 3,
2005)
In order to ensure that OPPS claims are being submitted and processed to payment in
accordance with OPPS payment policy, CMS must be able to monitor information
reported by hospitals on Form CMS-1450 in Form Locators (FLs) 22 (Patient Status) and
76 (Reason for Patient Visit). This instruction requires the Shared System Maintainer to
make changes to ensure that the information in FLs 22 and 76, from claims submitted on
bill type 13x, is passed to the OPPS Outpatient Code Editor (OCE) and to the Common
Working File (CWF). This instruction also requires the Common Working File
Maintainer to make changes to ensure that the information in FL 76, from claims
submitted on bill type 13x, is passed to the National Claims History (NCH) files.