CMS Reverses 2021 Changes To Inpatient Only List

Premier Pulse     January 2022

Maigur_HS_350x350By Andrew Maigur, MD, system director, Physician Advisor Program

On Nov. 2, 2021, the Centers for Medicare & Medicaid Services (CMS) released the anticipated CY 2022 Hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system final rule, finalizing this year’s Medicare payment rates for hospital outpatient and ASCs as well as regulatory guidance regarding several high-profile policies for hospitals. CMS evaluated industry feedback to the proposed modifications, including the halting of the elimination of the inpatient only list (IPO).

Changes To The Inpatient Only List

In the proposed rule, CMS suggested reinstating the 298 services removed from the IPO list Jan. 1, 2021, with an effective add back date of Jan. 1, 2022. In the final rule, CMS paused the elimination of the inpatient only list due in part to receiving overwhelming stakeholder feedback arguing that patients’ safety would be at far greater risk with a total elimination.

The final rule adds back to the IPO list all the services removed in 2021 except for three distinct procedures and their associated anesthesia codes. The services described by the following CPT codes will remain off the IPO list:

  • 22630 (lumbar spine fusion)
  • 23472 (reconstruct shoulder joint)
  • 27702 (reconstruct ankle joint)
  • The anesthesia codes corresponding to these procedures

It is important to consider that, as in the previous rulemaking, CMS emphasized that "the removal of a service from the IPO list does not require the services to be performed only on an outpatient basis." And providers should keep in mind that:

"It is a misinterpretation of CMS payment policy for providers to create policies or guidelines that establish the hospital outpatient setting as the baseline or default site of service for a procedure based on its removal from the IPO list. As stated in previous rulemaking, services that are no longer included on the IPO list are payable in either the inpatient or hospital outpatient setting." (CMS–1753–FC pg. 587/1394 and 84 FR 61354; 82 FR 59384; 81 FR 79697)

As physician advisors, we will continue to monitor the impact of these changes on our patients, providers and health system and advocate on your behalf. My team of physician advisors and I are more than willing to bear the regulatory burden and assist you with status determinations on these patients. Please feel free to contact the Physician Advisor Group via secure chat to reach an on-call physician advisor with any questions. 

Source: CMS OPPS/ASC Final Rule Increases Price Transparency, Patient Safety and Access to Quality Care

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