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Federal Policy·July 28, 2026
CMS Proposes Removing 638 Additional Procedures from Medicare Inpatient-Only List for 2027
CMS proposed removing 638 procedures from the Medicare Inpatient Only List in the CY 2027 OPPS/ASC Proposed Rule, effective January 1, 2027. This follows removal of 285 procedures in CY 2026. The broader scope includes surgical services beyond the 2026 focus on musculoskeletal procedures. The removals affect whether procedures must be performed in inpatient settings or can shift to outpatient settings under Medicare payment rules.
Why it matters
Medicaid managed care plans that follow Medicare payment methodologies or use Medicare's IPO List for prior authorization criteria will need to update utilization management protocols and network adequacy assessments as services shift from inpatient to outpatient settings.
Managed Care
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