2022 Medicare Inpatient Only Lists
The 2022 Medicare Inpatient Only (IPO) lists by specialty are now available for American College of Physician Advisor (ACPA) members! These contain both "inpatient only" procedures and "not inpatient only" procedures in different columns to assist you in identifying the right procedure.
Similar to prior years, the lists are organized into 16 specialties that are further divided by organ system, anatomic location, or purpose (depending on what makes the most sense for that specialty). Minor procedures that are obviously not inpatient only are sometimes omitted (such as screening colonoscopy or transthoracic echocardiography). Anesthesia, laboratory, and drug codes are, as a rule, omitted from the lists, as well.
As many of you know, the Centers for Medicare and Medicaid Services (CMS) reversed its decision to abolish the IPO list over three years, after the first year of phaseouts in 2021. Of the almost 300 procedures removed on January 1, 2021, all but three of them have been placed back on the inpatient only list for CY 2022. These three include total shoulder arthroplasty, total ankle arthroplasty, and one type of anterior column lumbar fusion surgery. CMS also finalized the return of a two-year exemption on denials for level of care for each procedure removed from the IPO list. Since these three procedures were removed at the beginning of 2021, they are exempted until the beginning of 2023. We have highlighted them green in these lists. The almost 300 procedures placed back on the inpatient only list as of January 1, 2022, are highlighted in blue. The other highlighting you will see is yellow for new codes (whether inpatient only or not inpatient only). We generally also annually remove discontinued and non-payable codes for Medicare. The presence of the code on the list, however, does not mean Medicare automatically covers the service. Medicare coverage of CPT codes is typically administered at the MAC level.
Similar to prior years, there is a compilation file of all the specialty specific lists. This will be most useful when searching for a CPT code or a keyword - just use the CTRL-F function in your pdf browser.
Do not post any of these lists on the internet, please. Members may share them with staff at their institutions who can benefit from them, but encourage them to join ACPA for all the other educational and networking opportunities ACPA provides!
Once again, we emphasize that the official IP only list remains CMS OPPS Addendum E, and that the CPT codeset is owned and maintained by the American Medical Association (AMA). The official references remain the "source of truth," and these lists cannot be relied upon as definitive information.