14. Department of Health and Human Services · Notable
Advance Medicare site neutrality by eliminating the inpatient-only list
Printed page 464 14. Department of Health and Human Services
“Additionally, regulations should advance site neutrality by eliminating the inpatient-only list and expanding the ambulatory surgical center covered procedures list. … CMS should expand the application of site-neutral payment options to more settings.”
What has happened
- Partially done
The CY 2026 OPPS/ASC final rule (effective 2026-01-01) finalizes the phase-out of the Inpatient Only list over three years, beginning with the removal of 285 mostly musculoskeletal services for CY 2026; modifies the ASC general standard criteria and eliminates five exclusion criteria, adding 276 procedures to the ASC Covered Procedures List plus the 271 codes coming off the IPO list; and removes the payment incentive for drug administration in acquired off-campus provider-based departments. CMS's own words: "Across the OPPS we are finalizing policies, like the elimination of the Inpatient Only List and changes to the Ambulatory Surgical Center Covered Procedures List." `partial` rather than `done` because the IPO list still holds roughly 1,450 services and the phase-out does not complete until CY 2028.
- Attempted
CMS proposed the CY 2026 OPPS/ASC rule, which proposed to resume phasing out the Inpatient Only (IPO) list, to loosen the ASC Covered Procedures List criteria, and sought comment on adjusting OPPS payment for services predominantly performed in ambulatory surgical center or physician office settings. Proposal only; nothing had changed.
Research log
What was searched, and what didn’t count as evidence
Research notes
- The operative text was read at https://www.govinfo.gov/content/pkg/FR-2025-11-25/html/2025-20907.htm (3.5 MB; the Federal Register’s own full-text page shows a “Request Access” page and cannot be used).
- History matters here: CMS finalized a three-year IPO elimination in the CY 2021 OPPS rule and reversed it in CY 2022, returning most services to the list. The CY 2026 rule restarts that elimination, which is why the first phase is again musculoskeletal services.
- Shares its Evidence with #1265 (the Requires-Congress version of the same site-neutrality ask, p. 465) and with #1292; each item states what its own Quote asked for.
- Action
- eliminate
- Object
- Medicare inpatient-only list and site-neutral payment
- ID
- 1258