A CPT procedure on the CMS inpatient-only list is performed. What is the key outpatient payment implication for hospital OPPS?
Select an answer to reveal the explanation.
Short Explanation
Inpatient-only means exactly that for hospital OPPS—Medicare isn’t buying that surgery as an outpatient facility service. It’s on a special list that points toward inpatient admission for payment. A modifier won’t magic it onto an outpatient APC.
Full Explanation
CMS maintains an inpatient-only procedure list of CPT codes generally excluded from OPPS payment; facility reimbursement is expected under inpatient admission and IPPS when covered. Modifier -25 does not convert inpatient-only procedures into outpatient-payable services. The list is a facility OPPS concept, not merely a professional-claim rule.