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April 22, 2015

Inpatient Only Services

"Inpatient only" services are generally, but not always, surgical services that require inpatient care because of the nature of the procedure, the typical underlying physical condition of patients who require the service, or the need for at least 24 hours of postoperative recovery time or monitoring before the patient can be safely discharged.

The policies related to inpatient only services are located in the CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 4, section 180.7External PDF.

A list of inpatient only services is updated annually in the Hospital Outpatient Prospective Payment System (OPPS) Final Rule. The Calendar Year (CY) 2015 list can be found in either of the following:

  • Addendum E is located in the CY2015 OPPS AddendaExternal Website file listed under Related Links.
  • Addendum BExternal Website is updated and published quarterly.
    • Inpatient-only services are assigned status indicator C.
    • Open the appropriate file for the date of service on the claim. For example, if the date of service on your claim is April 1, 2015 through April 3, 2015, open the April 2015 Addendum B file.
    • To group the list of codes assigned status indicator C:
      • Click on the SI column (column C).
      • Select "Data" and then "Sort A to Z".

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