GuidingCare is updating to the 2021 CMS Inpatient Only list on August 23

Effective Aug. 23, 2021, we’ll update GuidingCare to include the 2021 Centers for Medicare and Medicaid Services (CMS) Inpatient Only list for guidance on appropriate procedure settings.

The CMS Inpatient Only list is a list of procedures that Medicare will pay for when care takes place in a hospital inpatient setting. The update list has more services payable when completed in outpatient or ambulatory service center (ASC) locations, which gives you more options to reduce the cost of care for your patients. If criteria isn’t met indicating that a service should be completed in an inpatient setting, authorizations may deny if the procedure is not on the inpatient only list and is more appropriate for an outpatient setting.

Why are we making this change?

Our goal is to work with you to optimize health outcomes while providing evidence-based, value-driven care. Updating to the 2021 CMS Inpatient Only list ensures we’re using the most current criteria with reviewing our authorizations.

What does this mean for me?

There’s no change to the process you use to submit procedures for authorization. You can use the procedure location as one possible lever in reducing total cost of care and to save patients money by providing care within an outpatient or ambulatory surgical center (ASC) setting.

Visit the CMS Hospital and Outpatient regulations webpage to see specific procedures removed from the CMS inpatient only list.