What is Medicare Inpatient Only List?

The Medicare Inpatient Only (IPO) list is a list of procedures and services that CMS/Medicare considers appropriate for inpatient hospital care only.

Whenever one of these surgeries is done in the hospital, Inpatient billing can be done irrespective of the length of stay [LOS]. These procedures are complex, invasive, or high-risk and need inpatient hospital stay and resources for optimal outcomes.

The post operative care and monitoring of the patient post procedure can be time taking or complicated requiring high intensity of care.

This list is updated every year. So, it’s important to have the latest list with us while reviewing the statuses of patients. We can get updated list of Medicare Inpatient Only [IPO] from ACPA website. This list from this website is restricted to its members only. If you happen to work for commercial payers, I am sure they provide the list for you.

When I review a post operative patient’s status, I google to find out CPT code of a procedure performed and look it up if it’s an IPO procedure or not. If it’s in the list, I upgrade the status to Inpatient. If the patient is denied by a Medical Director even though patient underwent a procedure from IPO list, then I choose to Peer to peer review. Most of the times, Denial will be overturned. If denial is upheld during peer-to-peer review, I ask for a written appeal.