2023 Medicare Inpatient Only Lists
The 2023 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. The design is to give you a more thorough view of the codeset that currently exists, so you can identify nuances that may swing a procedure between an inpatient (IP) only procedure or not an IP only 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.
The major change this year is a new set of CPT codes to describe anterior abdominal wall hernia procedures. With this change, CMS has specified some of these procedures to be Inpatient Only for 2023. This will lead to some confusion as anterior hernia procedures were rarely Inpatient Only prior to 2023. Recognizing when a hernia procedure becomes an Inpatient Only procedure will be important to prevent revenue loss. We have created a graphic that attempts to explain in which situations an anterior abdominal wall hernia can become inpatient only. It may depend on whether a hernia is reducible, the total length of hernia defect, and the type of mesh used. We hope you will find this useful in your own education and the education of your medical staffs.
CMS also removed a handful of facial fracture CPT codes from the Inpatient Only list for 2023, and a few other minor changes as well. Every year, there are also new codes added, some of which will also be Inpatient Only. 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) which revises code descriptions from time to time which may not be reflected in these lists. The HCPCS codes are maintained by CMS. These official references remain the "source of truth," and these ACPA lists cannot be relied upon as definitive information.
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!