US · guidance
CMS Pub. 100-04, ch. 4, § 40.2.1
Patient Status Code and Reason for Patient Visit for the
Hospital OPPS
(Rev. 1107, Issued: 11-09-06, Effective: 07-01-07, Implementation: 07-02-07)
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 the claim including Patient Status and Reason for Patient Visit.
This instruction requires the Shared System Maintainer to make changes to ensure that
the information 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 regarding Reason for Patient Visit is passed to the National Claims History
(NCH) file.
History
(Rev. 1107, Issued: 11-09-06, Effective: 07-01-07, Implementation: 07-02-07)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
580a524b85cc0252ba37fbedc38212e8304d6ff2b18a9b4b4410dc24a46a486f
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