298 musculoskeletal-related procedures could return to CMS' inpatient-only list in 2022

Alan Condon -  

CMS has proposed bringing back the 298 primarily musculoskeletal-related services removed this year from its inpatient-only list for 2022.

The 2022 Hospital Outpatient Prospective Payment System and ASC Payment System proposed rule, published July 19, also would reinstate the inpatient-only list and remove 258 of the 266 procedures added to the ASC covered procedures list in January.

The proposal to stop the elimination of the IPO list came after a large number of stakeholders had concerns about patient safety.

Particular concerns were raised about complex procedures most often performed in the inpatient setting such as amputations and major trauma, including pelvic, acetabulum, hip and fragility fractures.

Such procedures cannot be safely performed in the outpatient setting, and this practice may even "breach the standard of care," the American Academy of Orthopaedic Surgeons said in an April 22 statement on recent CMS changes.

CMS' 2022 proposal would ensure that any service removed from the IPO list has been reviewed against its IPO list criteria to determine if it is appropriate to pay for the service in the outpatient setting.

The agency is also proposing to "codify the longstanding criteria for removal of procedures from the IPO list to make clear in regulatory text how we will evaluate future procedures for removal."

CMS is accepting comments on the 2022 proposed rule through Sept. 17.

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