List of codes on Inpatient List typically provided as
Addendum E on OPPS proposed rule.
Background
- The inpatient list (introduced in the April 7, 2000
final rule with comment period, 65 FR 18455) specifies those services that are
only paid when provided in an inpatient setting because of:
-
- The nature of the procedure,
- The need for at least 24 hours of postoperative recovery time or
monitoring before the patient can be safely discharged, or
- The underlying physical condition of the patient.
Criteria for removing from list and assigning to APC
group:
- November 30, 2001 OPPS final
rule (66 FR 59884)
-
- Most outpatient
departments are equipped to provide the services to the Medicare
population.
- The simplest procedure described
by the code may be performed in most outpatient departments.
- The procedure is related to codes
that we have already removed from the inpatient list
- November 1, 2002 final
rule with comment period (67 FR 66739)
-
- We have determined that the procedure is being performed in numerous
hospitals on an outpatient basis; or
- We have determined that the procedure can be appropriately and
safely performed in an ASC, and is on the list of approved ASC procedures or
has been proposed by us for addition to the ASC list.
Methodology to identify procedures currently on the
inpatient list being performed a significant amount of the time on an
outpatient basis:
- For CY 2009, used methodology as described in the November 15, 2004
final rule with comment period (69 FR 65835).
- These procedures were then clinically reviewed for possible removal
from the inpatient list.
- CMS solicited the APC Panel’s input at its March 2008 meeting on the
appropriateness of removing the CPT codes from the inpatient list.