The list of initial public offerings details the Common Health Care Procedure Coding System (HCPCS) codes for procedures that Medicare will only cover in case of hospitalization. Medicare Part A covers inpatient treatments. Whether or not a procedure is on the Medicare inpatient list (IOL) has important consequences for patients and providers. To properly use the IOL, it is essential to understand the world of ambulatory surgery; for example, the definition of what constitutes an outpatient procedure may vary depending on the payer.
Whatever the definition, the proportion of procedures performed on an outpatient basis is increasing. The Medicare IOL can be a tool to help make some of these determinations, but the purpose and implications of the list are often misunderstood. Created by the Centers for Medicare and Medicaid Services (CMS) in 2000, the list of IPOs designates specific surgeries or procedures as exclusively for hospitalized patients due to their invasive nature, since they require at least 24 hours of postoperative recovery or due to the patient's underlying physical condition. The procedures on this list must be performed in a hospital setting for Medicare to cover them under the Prospective Outpatient Payment System (OPPS).).
The purpose of the OPI is to determine the procedures by which a person must receive hospital care to receive Medicare coverage. The LUGPA has consistently opposed the list of initial public offerings, arguing that it imposes unnecessary barriers to access and hinders the ability of doctors to take advantage of innovation to provide safe, cost-effective and convenient patient care. Having an outpatient patient in bed, under observation, or in any other situation during an initial public offering procedure can result in interruptions in payment or even denial of payment for the procedure.
