Effective for DOS on and after April 1, 2013, certain surgical procedures may be reimbursed only when performed in an inpatient hospital, indicated by POS code 21 (Inpatient Hospital), or an ASC, indicated by POS 24 (Ambulatory Surgical Center).
Providers billing these services on professional claims (i.e., the 837P transaction or the 1500 Health Care Claim Form) are affected by this policy.
The following table lists services that may be reimbursed only when performed in an inpatient hospital. This list may be periodically updated.
21179 | 21180 | 21182 | 21183 | 22010 | 22015 | 22116 | 22216 | 22226 | 22318 |
22319 | 22328 | 22532 | 22533 | 22534 | 22551 | 22552 | 22633 | 22634 | 22804 |
22808 | 22841 | 22843 | 22844 | 22847 | 22848 | 32096 | 32097 | 32501 | 32503 |
32504 | 32505 | 32506 | 32507 | 32666 | 32667 | 32668 | 32669 | 32671 | 32674 |
33031 | 33140 | 33250 | 33251 | 33257 | 33258 | 33259 | 33261 | 33410 | 33416 |
33426 | 33427 | 33500 | 33507 | 33530 | 33548 | 33620 | 33622 | 33768 | 33774 |
33776 | 33777 | 33778 | 33779 | 33780 | 33813 | 33814 | 33852 | 33864 | 33880 |
33881 | 33883 | 33884 | 33889 | 33891 | 33916 | 33924 | 33925 | 33926 | 33968 |
33979 | 33980 | 33981 | 33982 | 34833 | 34834 | 34900 | 35633 | 39560 | 39561 |
43314 | 43327 | 44126 | 44127 | 44128 | 44132 | 44135 | 44202 | 44203 | 44204 |
44205 | 44210 | 44211 | 44212 | 44227 | 45126 | 45395 | 45397 | 47361 | 47362 |
49203 | 49204 | 49205 | 50250 | 50545 | 50546 | 50547 | 50548 | 57111 | 57112 |
58146 | 58293 | 58953 | 58956 | 59525 | 60650 | 61316 | 61517 | 61697 | 61698 |
62148 | 62161 | 62162 | 62163 | 62164 | 62165 | 92970 | 93463 | 99190 | 99191 |
99192 | 99356 | 99357 | 99460 | 99462 | 99463 | 99468 | 99469 | 99471 | 99472 |
99475 | 99476 | 99477 | 99478 | 99479 | 99480 |
The following table lists services that may be reimbursed only when performed in an inpatient hospital or ASC. The list may be periodically updated.
01990 | 19305 | 19306 | 19361 | 19368 | 20661 | 20802 | 20805 | 20808 | 20816 |
20824 | 20955 | 20956 | 20962 | 20969 | 20970 | 21154 | 21155 | 21159 | 21160 |
21188 | 21194 | 21247 | 21268 | 21344 | 21347 | 21348 | 21366 | 21423 | 21431 |
21432 | 21433 | 21435 | 21436 | 21510 | 21615 | 21616 | 21620 | 21630 | 21632 |
21705 | 21740 | 21750 | 21810 | 22110 | 22112 | 22114 | 22210 | 22212 | 22214 |
22220 | 22224 | 22325 | 22326 | 22327 | 22548 | 22556 | 22590 | 22595 | 22610 |
22800 | 22802 | 22810 | 22812 | 22818 | 22819 | 22842 | 22849 | 22852 | 22857 |
23200 | 23210 | 23220 | 23332 | 23900 | 23920 | 24900 | 24920 | 24930 | 24940 |
25900 | 25905 | 25915 | 25920 | 25927 | 26551 | 26553 | 27030 | 27036 | 27054 |
27070 | 27071 | 27075 | 27076 | 27077 | 27078 | 27090 | 27091 | 27120 | 27122 |
27125 | 27132 | 27134 | 27137 | 27138 | 27140 | 27146 | 27147 | 27151 | 27156 |
27158 | 27161 | 27165 | 27170 | 27175 | 27177 | 27178 | 27181 | 27185 | 27187 |
27215 | 27217 | 27218 | 27222 | 27226 | 27227 | 27228 | 27232 | 27236 | 27240 |
27244 | 27245 | 27248 | 27253 | 27254 | 27258 | 27259 | 27280 | 27282 | 27284 |
27286 | 27290 | 27295 | 27365 | 27445 | 27448 | 27450 | 27454 | 27465 | 27466 |
27468 | 27470 | 27472 | 27485 | 27486 | 27487 | 27488 | 27495 | 27506 | 27507 |
27511 | 27513 | 27514 | 27519 | 27556 | 27557 | 27558 | 27580 | 27590 | 27591 |
27592 | 27596 | 27598 | 27645 | 27646 | 27702 | 27703 | 27712 | 27725 | 27727 |
27880 | 27881 | 27882 | 27888 | 28800 | 31230 | 31360 | 31365 | 31367 | 31368 |
31370 | 31380 | 31382 | 31390 | 31395 | 31584 | 31587 | 31725 | 31760 | 31766 |
31770 | 31775 | 31780 | 31781 | 31786 | 31800 | 31805 | 32035 | 32036 | 32100 |
32110 | 32120 | 32124 | 32140 | 32141 | 32150 | 32151 | 32160 | 32200 | 32215 |
32220 | 32225 | 32310 | 32320 | 32440 | 32442 | 32445 | 32480 | 32482 | 32484 |
32486 | 32488 | 32540 | 32652 | 32663 | 32665 | 32800 | 32810 | 32815 | 32820 |
32850 | 32851 | 32852 | 32853 | 32854 | 32855 | 32856 | 32900 | 32905 | 32906 |
32940 | 32997 | 33015 | 33020 | 33025 | 33030 | 33050 | 33120 | 33130 | 33141 |
33202 | 33203 | 33236 | 33237 | 33238 | 33243 | 33254 | 33255 | 33256 | 33265 |
33266 | 33300 | 33305 | 33310 | 33315 | 33320 | 33322 | 33330 | 33332 | 33335 |
33400 | 33401 | 33403 | 33404 | 33405 | 33406 | 33411 | 33412 | 33413 | 33414 |
33415 | 33417 | 33420 | 33422 | 33425 | 33430 | 33460 | 33463 | 33464 | 33465 |
33468 | 33470 | 33471 | 33472 | 33474 | 33475 | 33476 | 33478 | 33496 | 33501 |
33502 | 33503 | 33504 | 33505 | 33506 | 33510 | 33511 | 33512 | 33513 | 33514 |
33516 | 33517 | 33518 | 33519 | 33521 | 33522 | 33523 | 33533 | 33534 | 33535 |
33536 | 33542 | 33545 | 33572 | 33600 | 33602 | 33606 | 33608 | 33610 | 33611 |
33612 | 33615 | 33617 | 33619 | 33641 | 33645 | 33647 | 33660 | 33665 | 33670 |
33675 | 33676 | 33677 | 33681 | 33684 | 33688 | 33690 | 33692 | 33694 | 33697 |
33702 | 33710 | 33720 | 33722 | 33724 | 33726 | 33730 | 33732 | 33735 | 33736 |
33737 | 33750 | 33755 | 33764 | 33766 | 33767 | 33770 | 33771 | 33786 | 33788 |
33800 | 33802 | 33803 | 33820 | 33822 | 33824 | 33840 | 33845 | 33851 | 33853 |
33860 | 33863 | 33870 | 33875 | 33877 | 33910 | 33915 | 33917 | 33920 | 33922 |
33930 | 33933 | 33935 | 33940 | 33944 | 33945 | 33960 | 33961 | 33967 | 33970 |
33971 | 33973 | 33974 | 33975 | 33976 | 33977 | 33978 | 34001 | 34051 | 34151 |
34401 | 34451 | 34502 | 34800 | 34802 | 34803 | 34804 | 34805 | 34806 | 34808 |
34812 | 34820 | 34825 | 34826 | 34830 | 34831 | 34832 | 35001 | 35002 | 35013 |
35021 | 35022 | 35081 | 35082 | 35091 | 35092 | 35102 | 35103 | 35111 | 35112 |
35121 | 35122 | 35131 | 35132 | 35141 | 35142 | 35151 | 35152 | 35182 | 35189 |
35211 | 35216 | 35221 | 35241 | 35246 | 35251 | 35271 | 35276 | 35281 | 35301 |
35302 | 35311 | 35331 | 35341 | 35351 | 35355 | 35361 | 35363 | 35371 | 35372 |
35390 | 35400 | 35501 | 35506 | 35508 | 35509 | 35511 | 35515 | 35516 | 35518 |
35521 | 35526 | 35531 | 35533 | 35536 | 35538 | 35539 | 35540 | 35556 | 35558 |
35560 | 35563 | 35565 | 35566 | 35571 | 35583 | 35585 | 35587 | 35600 | 35601 |
35606 | 35612 | 35621 | 35623 | 35626 | 35631 | 35636 | 35637 | 35638 | 35642 |
35645 | 35646 | 35650 | 35654 | 35656 | 35661 | 35663 | 35665 | 35666 | 35671 |
35681 | 35682 | 35683 | 35691 | 35693 | 35694 | 35695 | 35697 | 35700 | 35800 |
35840 | 35870 | 35905 | 35907 | 36660 | 36822 | 37140 | 37160 | 37180 | 37181 |
37182 | 37616 | 37617 | 37660 | 37788 | 38100 | 38101 | 38102 | 38115 | 38381 |
38382 | 38562 | 38564 | 38724 | 38747 | 38765 | 38770 | 38780 | 39200 | 39220 |
39501 | 39503 | 39540 | 39541 | 41135 | 41140 | 41145 | 41150 | 41153 | 41155 |
42426 | 42845 | 42894 | 42961 | 42971 | 43045 | 43101 | 43107 | 43108 | 43112 |
43113 | 43116 | 43117 | 43121 | 43122 | 43123 | 43124 | 43310 | 43312 | 43325 |
43330 | 43331 | 43340 | 43341 | 43350 | 43351 | 43352 | 43360 | 43361 | 43400 |
43405 | 43415 | 43425 | 43460 | 43496 | 43501 | 43502 | 43605 | 43610 | 43611 |
43620 | 43621 | 43622 | 43631 | 43632 | 43633 | 43634 | 43640 | 43641 | 43800 |
43810 | 43820 | 43825 | 43832 | 43840 | 43846 | 43847 | 43850 | 43855 | 43860 |
43865 | 43881 | 43882 | 44010 | 44015 | 44021 | 44025 | 44111 | 44120 | 44121 |
44139 | 44140 | 44144 | 44145 | 44146 | 44147 | 44150 | 44151 | 44155 | 44156 |
44157 | 44158 | 44160 | 44300 | 44310 | 44314 | 44316 | 44320 | 44322 | 44345 |
44604 | 44605 | 44625 | 44626 | 44660 | 44661 | 44680 | 44700 | 44720 | 44721 |
44800 | 44960 | 45110 | 45111 | 45112 | 45114 | 45116 | 45119 | 45120 | 45121 |
45130 | 45135 | 45540 | 45550 | 45563 | 45805 | 45825 | 46730 | 46735 | 46742 |
46744 | 46746 | 46748 | 47010 | 47100 | 47120 | 47122 | 47125 | 47130 | 47133 |
47135 | 47140 | 47142 | 47143 | 47144 | 47145 | 47146 | 47147 | 47300 | 47350 |
47360 | 47380 | 47381 | 47400 | 47420 | 47425 | 47460 | 47480 | 47550 | 47600 |
47605 | 47610 | 47612 | 47620 | 47700 | 47701 | 47711 | 47712 | 47715 | 47720 |
47721 | 47740 | 47741 | 47760 | 47765 | 47780 | 47785 | 47800 | 47900 | 48020 |
48100 | 48105 | 48120 | 48145 | 48146 | 48148 | 48150 | 48152 | 48153 | 48154 |
48155 | 48400 | 48500 | 48520 | 48540 | 48545 | 48547 | 48548 | 48551 | 48554 |
48556 | 49020 | 49040 | 49060 | 49062 | 49428 | 49605 | 49611 | 49905 | 50010 |
50040 | 50045 | 50060 | 50065 | 50070 | 50075 | 50100 | 50120 | 50125 | 50130 |
50135 | 50205 | 50220 | 50225 | 50234 | 50236 | 50240 | 50280 | 50290 | 50300 |
50320 | 50323 | 50325 | 50327 | 50328 | 50340 | 50360 | 50365 | 50370 | 50380 |
50400 | 50405 | 50500 | 50520 | 50540 | 50600 | 50605 | 50610 | 50620 | 50630 |
50650 | 50660 | 50700 | 50715 | 50722 | 50725 | 50740 | 50750 | 50760 | 50770 |
50780 | 50782 | 50783 | 50785 | 50800 | 50810 | 50815 | 50820 | 50825 | 50830 |
50840 | 50860 | 50900 | 50920 | 50930 | 50940 | 51525 | 51530 | 51550 | 51555 |
51565 | 51570 | 51575 | 51580 | 51585 | 51590 | 51595 | 51596 | 51597 | 51800 |
51820 | 51841 | 51865 | 51900 | 51920 | 51925 | 51940 | 51960 | 51980 | 54125 |
54130 | 55801 | 55810 | 55812 | 55815 | 55821 | 55831 | 55840 | 55845 | 56630 |
56631 | 56632 | 56633 | 56634 | 56637 | 56640 | 57110 | 57270 | 57280 | 57305 |
57307 | 57308 | 57311 | 57531 | 57540 | 57545 | 58140 | 58150 | 58152 | 58180 |
58200 | 58210 | 58240 | 58275 | 58280 | 58285 | 58548 | 58605 | 58611 | 58822 |
58825 | 58940 | 58943 | 58950 | 58951 | 58952 | 58954 | 58957 | 58958 | 59130 |
59136 | 59140 | 59350 | 59514 | 59620 | 59852 | 59855 | 59856 | 60254 | 60270 |
60505 | 60521 | 60522 | 60540 | 60545 | 60600 | 60605 | 61105 | 61107 | 61108 |
61120 | 61140 | 61150 | 61151 | 61154 | 61156 | 61210 | 61250 | 61304 | 61305 |
61312 | 61313 | 61314 | 61315 | 61320 | 61321 | 61333 | 61340 | 61343 | 61345 |
61440 | 61450 | 61458 | 61460 | 61480 | 61490 | 61500 | 61501 | 61510 | 61512 |
61514 | 61516 | 61518 | 61519 | 61520 | 61521 | 61522 | 61524 | 61526 | 61530 |
61531 | 61533 | 61534 | 61535 | 61536 | 61537 | 61538 | 61539 | 61540 | 61541 |
61542 | 61543 | 61544 | 61545 | 61546 | 61548 | 61550 | 61552 | 61556 | 61557 |
61558 | 61559 | 61563 | 61564 | 61566 | 61567 | 61570 | 61571 | 61575 | 61580 |
61581 | 61582 | 61583 | 61584 | 61585 | 61586 | 61590 | 61591 | 61592 | 61595 |
61596 | 61597 | 61598 | 61600 | 61601 | 61605 | 61606 | 61607 | 61608 | 61609 |
61610 | 61612 | 61613 | 61615 | 61616 | 61618 | 61619 | 61680 | 61682 | 61684 |
61686 | 61690 | 61692 | 61700 | 61702 | 61703 | 61705 | 61708 | 61710 | 61711 |
61735 | 61750 | 61751 | 61760 | 61860 | 61863 | 61864 | 61867 | 61868 | 61870 |
62005 | 62010 | 62100 | 62116 | 62117 | 62120 | 62121 | 62140 | 62141 | 62142 |
62143 | 62145 | 62146 | 62147 | 62180 | 62190 | 62192 | 62200 | 62201 | 62220 |
62223 | 62256 | 62258 | 63050 | 63051 | 63077 | 63078 | 63081 | 63082 | 63085 |
63086 | 63087 | 63088 | 63090 | 63091 | 63101 | 63102 | 63103 | 63170 | 63172 |
63173 | 63180 | 63182 | 63185 | 63190 | 63194 | 63195 | 63196 | 63197 | 63200 |
63250 | 63251 | 63252 | 63265 | 63266 | 63268 | 63270 | 63271 | 63272 | 63273 |
63275 | 63276 | 63277 | 63278 | 63280 | 63281 | 63282 | 63283 | 63285 | 63286 |
63287 | 63290 | 63295 | 63300 | 63301 | 63302 | 63303 | 63304 | 63305 | 63306 |
63308 | 63700 | 63702 | 63704 | 63706 | 63709 | 63710 | 63740 | 64752 | 64755 |
64760 | 64809 | 65273 | 69155 | 69535 | 69554 | 69950 | 92975 | 92992 | 92993 |