Inpatient Only CPT List


Glenville, NY
Best answers
CMS has a listing of CPT codes that can only be done as inpatient. Our hospital is now doing robotic surgery. Vaginal hysterectomies and hysterectomies are on the inpatient only list per Medicare's guidelines BUT we have recently seen two hysterectomies done robotically as outpatient surgery. We recently had Today's Options take back payment because a vaginal hysterectomy was done as outpatient and Today's Options cited Medicare's Inpatient Only List as the reason for denial.

I would like to know if anyone is aware of any changes or possible upcoming change to the CMS policy regarding the Inpatient Only List? Newer technology such as the robotic surgery is making the inpatient procedures less invasive so patients can now be done as outpatient. Has anyone had any experience with this and any billing denials because of the Inpatient Only Procedure? If so, I would appreciate anyone sharing how you are handling the billing for these procedures. Any advice or suggestions will be greatly appreciated! Thank you! :)