The Medicare Inpatient Only (IPO) list details the procedures that Medicare will cover in an inpatient setting. The Centers for Medicare & Medicaid Services (CMS) releases the IPO list each year.
The IPO list details the Healthcare Common Procedure Coding System (HCPCS) codes for the procedures that Medicare will only cover on an inpatient basis. Medicare Part A covers inpatient treatments.
Read on to learn more about the purpose of the IPO list, what it looks like, where to find the IPO list, and more.
The purpose of the IPO is to determine the procedures for which a person must receive inpatient care in order to receive Medicare coverage. It would typically not be safe to perform the procedures on the IPO list to outpatients.
The CMS created the list as part of the Outpatient Prospective Payment System (OPPS).
The OPPS is the system through which the CMS generally pays for services in a hospital outpatient facility. Medicare Part B covers outpatient procedures under the OPPS.
The CMS decided to issue the IPO list with the OPPS to detail procedures they will only cover on an inpatient basis. Medicare Part A covers inpatient hospital care.
The IPO list ensures that Medicare does not pay for inpatient procedures presented as outpatient services. This means that Medicare Part A covers the procedure rather than Medicare Part B.
This is important as there are different costs involved with parts A and B, both for Medicare and the beneficiary.
Historically, the CMS worked alongside other people and associations to add to or amend the IPO list. These include:
- surgeons
- hospitals
- hospital associations
- professional societies
- advocacy groups
Generally, the CMS considers whether a procedure is to be “inpatient only” based on:
- the type of the procedure
- whether the individual will require at least 24 hours of recovery or monitoring before discharge after the procedure
- the person’s underlying physical health
The CMS encourages people to request a review of a particular code or procedure on the IPO if they believe that the procedure is safe to perform on an outpatient basis.
The CMS releases the IPO annually at the end of the year. It is part of the OPPS.
The list goes into effect on January 1 each year.
The IPO is a long list of HCPCS Current Procedural Terminology (CPT) codes and descriptions. The American Medical Association (AMA) maintains the CPT coding system.
In 2024, the IPO contains over 1,730 HCPCS codes and descriptors.
A person can download the 2024 IPO list from the CMS website. To do so:
- Go to the CMS-1786-FC regulation page.
- Scroll down to the section at the bottom of the page titled “Related Links.”
- Click on “2024 NFRM OPPS Addenda.”
- Read and accept the license for use agreement to download the folder.
- Open the downloaded folder.
- Locate and open the file named “2024 NFRM Addendum E.11012023.xlsx”
If a person does not wish to download the folder, they can access the 2023 IPO list on the St. Charles Health System website. St. Charles Health System participates in some Medicare Advantage plans in Oregon.
They can then view the list of 10 additions to the 2024 IPO list in the January 2024 Update of the Hospital Outpatient Prospective Payment System (OPPS) document. The document lists the additions under “Table 8. – Changes to the IPO List for CY 2024.”
In 2021, the CMS originally began phasing out the IPO list by removing over 500 procedures.
However, the following year, the CMS reversed the decision to get rid of the IPO list.
Medicare Part A covers inpatient procedures. Part A coverage includes:
- inpatient care in the hospital
- care in a skilled nursing facility (SNF)
- hospice care
- some home health care
Learn about eligibility for Medicare Part A.
The Inpatient Only (IPO) list is a list of Healthcare Common Procedure Coding System (HCPCS) codes and descriptions that the Centers for Medicare & Medicaid Services (CMS) releases each year.
The IPO list details procedures that Medicare may cover as inpatient care. The CMS deems that it would be unsafe for an individual to undergo these procedures on an outpatient basis.
A person can download the IPO list on the CMS website. There are currently over 1,700 procedures on the list.