Q&A: Inpatient-Only Separate Procedure Exception

November 1, 2016
Medicare Web

Q: Could you please explain the separate procedure exception for inpatient-only procedures?

A: The separate procedure exception exists to allow partial payment if certain inpatient-only procedures are performed as an incidental part of an outpatient surgery. Two documents can help determine if this exception applies: Addendum B of the OPPS final rule, and the separate procedure list. Both of these documents can be downloaded from CMS’ website and saved for reference. For the separate procedure exception to apply, the outpatient surgery must be listed with status indicator (SI) “T” or “J1,” and the inpatient-only procedure must be on CMS’ separate procedure list. Both of these conditions must be met for the exception to apply.

For more information, refer to the Inpatient-Only Procedures Training Handbook .

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