diff --git a/hapi-fhir-base/src/main/java/ca/uhn/fhir/rest/api/MethodOutcome.java b/hapi-fhir-base/src/main/java/ca/uhn/fhir/rest/api/MethodOutcome.java
index c9bfa5aa2c9..909a9ad8dc8 100644
--- a/hapi-fhir-base/src/main/java/ca/uhn/fhir/rest/api/MethodOutcome.java
+++ b/hapi-fhir-base/src/main/java/ca/uhn/fhir/rest/api/MethodOutcome.java
@@ -40,7 +40,7 @@ public class MethodOutcome {
 	private IBaseResource myResource;
 	private Map<String, List<String>> myResponseHeaders;
 	private Collection<Runnable> myResourceViewCallbacks;
-	private int myResponseStatusCode;
+	private Integer myResponseStatusCode;
 
 	/**
 	 * Constructor
@@ -258,6 +258,10 @@ public class MethodOutcome {
 	}
 
 	public int getResponseStatusCode() {
-		return myResponseStatusCode;
+		return isResponseStatusCodeSet() ? myResponseStatusCode : 0;
+	}
+
+	public boolean isResponseStatusCodeSet() {
+		return myResponseStatusCode != null;
 	}
 }
diff --git a/hapi-fhir-client/src/main/java/ca/uhn/fhir/rest/client/method/MethodUtil.java b/hapi-fhir-client/src/main/java/ca/uhn/fhir/rest/client/method/MethodUtil.java
index 5021374f9b6..f5b7b991e22 100644
--- a/hapi-fhir-client/src/main/java/ca/uhn/fhir/rest/client/method/MethodUtil.java
+++ b/hapi-fhir-client/src/main/java/ca/uhn/fhir/rest/client/method/MethodUtil.java
@@ -544,6 +544,7 @@ public class MethodUtil {
 		}
 
 		MethodOutcome retVal = new MethodOutcome();
+		retVal.setResponseStatusCode(theResponseStatusCode);
 		if (locationHeaders.size() > 0) {
 			String locationHeader = locationHeaders.get(0);
 			BaseOutcomeReturningMethodBinding.parseContentLocation(theContext, retVal, locationHeader);
diff --git a/hapi-fhir-docs/src/main/resources/ca/uhn/hapi/fhir/changelog/7_0_0/5268-respect-response-status-code-of-method-outcome-from-resource-provider.yaml b/hapi-fhir-docs/src/main/resources/ca/uhn/hapi/fhir/changelog/7_0_0/5268-respect-response-status-code-of-method-outcome-from-resource-provider.yaml
new file mode 100644
index 00000000000..25e68ebabdb
--- /dev/null
+++ b/hapi-fhir-docs/src/main/resources/ca/uhn/hapi/fhir/changelog/7_0_0/5268-respect-response-status-code-of-method-outcome-from-resource-provider.yaml
@@ -0,0 +1,5 @@
+---
+type: fix
+issue: 5268
+title: "Previously, the response status code set in a `MethodOutcome` of a Resource provider was not respected.
+This has been fixed."
diff --git a/hapi-fhir-server/src/main/java/ca/uhn/fhir/rest/server/method/BaseOutcomeReturningMethodBinding.java b/hapi-fhir-server/src/main/java/ca/uhn/fhir/rest/server/method/BaseOutcomeReturningMethodBinding.java
index 93280afd985..e9c7e56458c 100644
--- a/hapi-fhir-server/src/main/java/ca/uhn/fhir/rest/server/method/BaseOutcomeReturningMethodBinding.java
+++ b/hapi-fhir-server/src/main/java/ca/uhn/fhir/rest/server/method/BaseOutcomeReturningMethodBinding.java
@@ -80,6 +80,12 @@ abstract class BaseOutcomeReturningMethodBinding extends BaseMethodBinding {
 	protected abstract String getMatchingOperation();
 
 	private int getOperationStatus(MethodOutcome response) {
+
+		// if the response status code is set (i.e. from a custom Resource provider) it should be respected
+		if (response.isResponseStatusCodeSet()) {
+			return response.getResponseStatusCode();
+		}
+
 		switch (getRestOperationType()) {
 			case CREATE:
 				validateResponseNotNullIfItShouldntBe(response);
diff --git a/hapi-fhir-structures-r4/src/test/java/ca/uhn/fhir/rest/server/ResponseCodeModifyingResourceProviderTest.java b/hapi-fhir-structures-r4/src/test/java/ca/uhn/fhir/rest/server/ResponseCodeModifyingResourceProviderTest.java
new file mode 100644
index 00000000000..c4526ff9ee6
--- /dev/null
+++ b/hapi-fhir-structures-r4/src/test/java/ca/uhn/fhir/rest/server/ResponseCodeModifyingResourceProviderTest.java
@@ -0,0 +1,77 @@
+package ca.uhn.fhir.rest.server;
+
+import ca.uhn.fhir.context.FhirVersionEnum;
+import ca.uhn.fhir.rest.annotation.Create;
+import ca.uhn.fhir.rest.annotation.IdParam;
+import ca.uhn.fhir.rest.annotation.ResourceParam;
+import ca.uhn.fhir.rest.annotation.Update;
+import ca.uhn.fhir.rest.api.MethodOutcome;
+import ca.uhn.fhir.rest.client.api.IGenericClient;
+import ca.uhn.fhir.test.utilities.server.RestfulServerExtension;
+import org.hl7.fhir.instance.model.api.IBaseResource;
+import org.hl7.fhir.r4.model.IdType;
+import org.hl7.fhir.r4.model.Patient;
+import org.junit.jupiter.api.BeforeEach;
+import org.junit.jupiter.api.Test;
+import org.junit.jupiter.api.extension.RegisterExtension;
+
+import javax.servlet.ServletRequest;
+
+import static ca.uhn.fhir.rest.api.Constants.STATUS_HTTP_202_ACCEPTED;
+import static org.junit.jupiter.api.Assertions.assertEquals;
+
+public class ResponseCodeModifyingResourceProviderTest {
+
+	public static final int CUSTOM_RESPONSE_CODE = STATUS_HTTP_202_ACCEPTED;
+
+	@RegisterExtension
+	private RestfulServerExtension myServer = new RestfulServerExtension(FhirVersionEnum.R4)
+		 .registerProvider(new TestResponseCodeModifyingPatientProvider());
+
+	private IGenericClient myClient;
+
+	private Patient myPatient;
+
+	@BeforeEach
+	public void before() {
+		myPatient = new Patient();
+		myPatient.getNameFirstRep().addGiven("John").setFamily("Smith");
+		myClient = myServer.getFhirClient();
+	}
+
+	@Test
+	public void testCreatePatientReturnsModifiedResponseCode() {
+		MethodOutcome outcome = myClient.create().resource(myPatient).execute();
+		assertEquals(CUSTOM_RESPONSE_CODE, outcome.getResponseStatusCode());
+	}
+
+	@Test
+	public void testUpdatePatientReturnsModifiedResponseCode() {
+		myPatient.setId("1");
+		MethodOutcome outcome = myClient.update().resource(myPatient).execute();
+		assertEquals(CUSTOM_RESPONSE_CODE, outcome.getResponseStatusCode());
+	}
+
+	class TestResponseCodeModifyingPatientProvider implements IResourceProvider {
+
+		@Create()
+		public MethodOutcome createPatient(@ResourceParam Patient thePatient, ServletRequest theServletRequest) {
+			MethodOutcome methodOutcome = new MethodOutcome();
+			methodOutcome.setResponseStatusCode(CUSTOM_RESPONSE_CODE);
+			return methodOutcome;
+		}
+
+		@Update()
+		public MethodOutcome updatePatient(@IdParam IdType theId, @ResourceParam Patient thePatient) {
+			MethodOutcome methodOutcome = new MethodOutcome();
+			methodOutcome.setResponseStatusCode(CUSTOM_RESPONSE_CODE);
+			return methodOutcome;
+		}
+
+		@Override
+		public Class<? extends IBaseResource> getResourceType() {
+			return Patient.class;
+		}
+	}
+
+}