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CMS reverses course on elimination of the inpatient-only service list

In yet another reversal by the Biden Administration of a Trump-era policy, CMS recently released a proposed rule reversing the Trump Administration’s decision to eliminate the Inpatient-only (“IPO”) service list over a three-year period. This proposed change will reinstate 298 procedures onto the IPO service list, and remove hundreds of procedures from the list of procedures (the “ASC List”) authorized to be performed in an Ambulatory Surgery Center (“ASC”).

As part of the Calendar Year 2021 Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System Final Rule (the “2021 Final Rule”), the Trump Administration “finalized a policy to eliminate the IPO list over a three-year period, removing 298 services from the IPO list in the first phase of the elimination” and “add[ing] 267 surgical procedures to the ASC [List].”

CMS proposed rule now seeks to reverse course on these changes. Going a step further, the CMS proposal would prevent future broad changes to the list by “codify[ing] the longstanding criteria for removal of procedures from the IPO list to make clear in regulatory text how [CMS] will evaluate future procedures for removal.” Moreover, the CMS’ proposal will “reinstate the criteria (which related to patient safety) for adding a procedure to the ASC List” in place prior to the Trump Administration changes.

If finalized, these proposed changes will have a significant impact on the types of procedures ASCs may perform and could result in a rebalancing of surgical volumes between hospitals and ASCs.

The deadline for interested parties to submit comments on the proposed changes is Sept. 17, 2021. CMS is expected to publish the final rule in November of 2021.

If you have any questions about these proposed changes, please contact Zack Trotter by phone at (205) 226-5743 or by e-mail at


Zachary Trotter
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Manning Russell
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