An Inpatient Only Procedure (IPO) is a defined set of procedures that, due to their medical complexity, Medicare and other payors will only pay when an inpatient status order is placed in the medical record. The Centers for Medicare and Medicaid Services (CMS) and other payors maintain an annual inpatient only procedure (IPO) list outlining applicable procedures. A procedure is considered an Inpatient Only Procedure (IPO) only if the patient has an IPO-approved payors and the procedure/code is on the IPO CPT list.
We have provided the list of Healthcare Common Procedure Coding Systems (HCPCS) codes and impacted payors for clinics to reference when scheduling procedures to ensure the patient is scheduled in the appropriate status. To search the IPO lists, press Ctrl + F on your keyboard, type the word or number you want to find and hit Enter.
An inpatient status is used before the procedure to ensure the correct cost estimate is provided to the patient and the correct authorization is obtained. An inpatient order is placed by the provider following the procedure to identify the appropriate level of care.
Due to their medical complexity, Medicare and other payors will only pay for IPO procedures when an inpatient status order is placed in the medical record. Having an outpatient in a bed, observation, or other status for an IPO procedure can lead to payment interruptions or even denial of payment for the procedure.
Yes, a CPT code must be provided for all requested procedures.
CPT codes are required to allow our system to identify IPO procedures and ensure that the department is prepared for the case on the day of service (DOS).
Yes, you should continue to send CPT codes for possible procedures. This not only allows our system to identify IPO procedures but also ensures that the department is prepared for the case on the day of service (DOS).
We recommend informing the physician to ensure an inpatient order is placed on the day of the procedure.
Routine audits are conducted to ensure patient's status is accurate. The system will alert Banner if the IPO procedure is not assigned the Inpatient status. Communication should occur between the hospital schedulers and the provider’s office to obtain an updated order. To prevent any delays, please address these requests promptly. Insurance authorization will need to be resubmitted by the physician’s office before the revised order is submitted.
An admit to inpatient order does not mean that the patient needs to stay overnight, the patient should be discharged when medically appropriate. Outpatient in a bed and observation orders should not be used for IPO procedures.
Depending on the patient’s insurance, the patient may be responsible for an inpatient copay/coinsurance. If an inpatient order is not placed, the claim may be denied, and the patient may be responsible for the entire bill.
CMS and other payors maintain the list annually.
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