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Inpatient Only List – March 2021 Coding Tip

The inpatient only list is composed of procedures for which Medicare will only pay for when performed in the hospital inpatient setting. CMS has determined this list to be an area of concern in that it restricts patient choice when it comes to surgery. CMS has proposed to eliminate the list over the next three years. The inpatient list was created 20 years ago to designate surgeries that require inpatient care because of the complex nature of the procedure, the need for extended recovery time, or the patient’s comorbidities.

For CY 2021, the following procedures have been removed from the inpatient only list:

  • 266 musculoskeletal procedures
  • 16 related anesthesia codes
  • 16 miscellaneous procedures to include gastrointestinal procedures, vascular procedures, and gynecological procedures

For a detailed list of the removed codes, go to the following CMS website: CMS-1736-FC | CMS.