What is the inpatient-only list and why is it important? Not following the list may affect your procedure reimbursement. Here is what you need to know. The inpatient-only list is a Medicare policy that is updated yearly. The list includes all procedures that CMS deems to require inpatient level of care due to the nature of the procedure, the severity of the underlying conditions of patients requiring the service, and or the need for more than 24 hours of postoperative recovery. While the list is mainly for patient safety, it also affects reimbursement. These procedures may only be performed as hospital inpatient procedures. If a procedure on the list is billed as an outpatient procedure, it will not be paid. The IPO list is maintained as part of the Outpatient Prospective Payment System and is released each year as part of the proposed and final rule. The list can be found in the addenda of the rule, typically in Appendix E. In 2021, CMS provided a policy for removing procedures from the IPO list. If the procedure meets the listed criteria, it can be removed. Requests for removal can be made as part of comments during the yearly rulemaking process. So what do you need to know to get IPO procedures paid? Talk to your hospital. Make sure they know that the patient's status needs to be inpatient. The 2 midnight rule does not apply for IPO procedures, so the length of stay is not a deciding factor. But it is important that the admission starts on the date of the procedure, unless the patient was admitted first. Also be aware that other insurers, especially Medicaid, follow CMS policies and may abide by the IPO list. This means that the procedure may require an inpatient authorization. Once again, communicate with hospital staff to ensure that the patient's status is correct. Having everyone on the same page is key for proper reimbursement.

inpatient-only list

Medicare policy

inpatient level of care

reimbursement

Outpatient Prospective Payment System