CMS Inpatient Only List Final Rule

While it has been under heavy consideration since July, CMS finalized its decision to add back nearly three hundred procedures to Inpatient only coverage. This reverses a Trump-era plane to phase out the list completely. Much of the list reduction can be tied back to COVID, when hospitals had to shut down elective surgeries to treat COVID patients.

Beyond adding the procedures back to Inpatient only, they have also established specific criteria to establish when a procedure could be removed from the list in the future. None of the procedures that were removed from the Inpatient Only list for 2021 met the previous criteria to decide whether the procedures should be removed.

The updated criteria CMS agreed upon to determine if a procedure should be removed include whether most Outpatient facilities are equipped to perform the procedure if it can be safely conducted in Outpatient settings and whether similar procedures were removed in the past.

Medtronic agrees with the Final Rule. “We believe this serves as solid evidence that continuing down the path of eliminating the IPO list in its entirety, rather than removing individual procedures or groups of clinically similar procedures on an incremental basis, would present safety and quality risks to Medicare beneficiaries.”

Nearly all the originally removed codes will be returned effective 2022. The exceptions include lumbar spine fusion, shoulder joint reconstruction, ankle reconstruction and corresponding anesthesia codes. Likewise, CMS agreed on the removal of 255 procedures added to the Ambulatory Surgical Center (ASC) covered procedure list under 2020’s final rule.

The fine line becomes a balance of the increasing wish to utilize ASC’s over traditional Hospital Outpatient facilities, specifically for Orthopedics. CMS’s decision to cover total knee and hip replacements in an Outpatient setting has certainly helped ASC volume. It was projected that “Outpatient centers will account for approximately 57% of him and knee replacements by 2028.”

As we move forward, we will continue to see a delicate balance between procedures moving from Inpatient Only to Outpatient. However, there will be a longer process to ensure patient safety remains key to the decision.


Leave a Comment

Your email address will not be published. Required fields are marked *