For Dates of Service On and After April 1, 2013, and Before January 1, 2014

Procedures Reimbursable Only as Inpatient Hospital or Ambulatory Surgery Center Services

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.

21179211802118221183220102201522116222162222622318
22319223282253222533225342255122552226332263422804
22808228412284322844228472284832096320973250132503
32504325053250632507326663266732668326693267132674
33031331403325033251332573325833259332613341033416
33426334273350033507335303354833620336223376833774
33776337773377833779337803381333814338523386433880
33881338833388433889338913391633924339253392633968
33979339803398133982348333483434900356333956039561
43314433274412644127441284413244135442024420344204
44205442104421144212442274512645395453974736147362
49203492044920550250505455054650547505485711157112
58146582935895358956595256065061316615176169761698
62148621616216262163621646216592970934639919099191
99192993569935799460994629946399468994699947199472
994759947699477994789947999480    

The following table lists services that may be reimbursed only when performed in an inpatient hospital or ASC. The list may be periodically updated.

01990193051930619361193682066120802208052080820816
20824209552095620962209692097021154211552115921160
21188211942124721268213442134721348213662142321431
21432214332143521436215102161521616216202163021632
21705217402175021810221102211222114222102221222214
22220222242232522326223272254822556225902259522610
22800228022281022812228182281922842228492285222857
23200232102322023332239002392024900249202493024940
25900259052591525920259272655126553270302703627054
27070270712707527076270772707827090270912712027122
27125271322713427137271382714027146271472715127156
27158271612716527170271752717727178271812718527187
27215272172721827222272262722727228272322723627240
27244272452724827253272542725827259272802728227284
27286272902729527365274452744827450274542746527466
27468274702747227485274862748727488274952750627507
27511275132751427519275562755727558275802759027591
27592275962759827645276462770227703277122772527727
27880278812788227888288003123031360313653136731368
31370313803138231390313953158431587317253176031766
31770317753178031781317863180031805320353203632100
32110321203212432140321413215032151321603220032215
32220322253231032320324403244232445324803248232484
32486324883254032652326633266532800328103281532820
32850328513285232853328543285532856329003290532906
32940329973301533020330253303033050331203313033141
33202332033323633237332383324333254332553325633265
33266333003330533310333153332033322333303333233335
33400334013340333404334053340633411334123341333414
33415334173342033422334253343033460334633346433465
33468334703347133472334743347533476334783349633501
33502335033350433505335063351033511335123351333514
33516335173351833519335213352233523335333353433535
33536335423354533572336003360233606336083361033611
33612336153361733619336413364533647336603366533670
33675336763367733681336843368833690336923369433697
33702337103372033722337243372633730337323373533736
33737337503375533764337663376733770337713378633788
33800338023380333820338223382433840338453385133853
33860338633387033875338773391033915339173392033922
33930339333393533940339443394533960339613396733970
33971339733397433975339763397733978340013405134151
34401344513450234800348023480334804348053480634808
34812348203482534826348303483134832350013500235013
35021350223508135082350913509235102351033511135112
35121351223513135132351413514235151351523518235189
35211352163522135241352463525135271352763528135301
35302353113533135341353513535535361353633537135372
35390354003550135506355083550935511355153551635518
35521355263553135533355363553835539355403555635558
35560355633556535566355713558335585355873560035601
35606356123562135623356263563135636356373563835642
35645356463565035654356563566135663356653566635671
35681356823568335691356933569435695356973570035800
35840358703590535907366603682237140371603718037181
37182376163761737660377883810038101381023811538381
38382385623856438724387473876538770387803920039220
39501395033954039541411354114041145411504115341155
42426428454289442961429714304543101431074310843112
43113431164311743121431224312343124433104331243325
43330433314334043341433504335143352433604336143400
43405434154342543460434964350143502436054361043611
43620436214362243631436324363343634436404364143800
43810438204382543832438404384643847438504385543860
43865438814388244010440154402144025441114412044121
44139441404414444145441464414744150441514415544156
44157441584416044300443104431444316443204432244345
44604446054462544626446604466144680447004472044721
44800449604511045111451124511445116451194512045121
45130451354554045550455634580545825467304673546742
46744467464674847010471004712047122471254713047133
47135471404714247143471444714547146471474730047350
47360473804738147400474204742547460474804755047600
47605476104761247620477004770147711477124771547720
47721477404774147760477654778047785478004790048020
48100481054812048145481464814848150481524815348154
48155484004850048520485404854548547485484855148554
48556490204904049060490624942849605496114990550010
50040500455006050065500705007550100501205012550130
50135502055022050225502345023650240502805029050300
50320503235032550327503285034050360503655037050380
50400504055050050520505405060050605506105062050630
50650506605070050715507225072550740507505076050770
50780507825078350785508005081050815508205082550830
50840508605090050920509305094051525515305155051555
51565515705157551580515855159051595515965159751800
51820518415186551900519205192551940519605198054125
54130558015581055812558155582155831558405584556630
56631566325663356634566375664057110572705728057305
57307573085731157531575405754558140581505815258180
58200582105824058275582805828558548586055861158822
58825589405894358950589515895258954589575895859130
59136591405935059514596205985259855598566025460270
60505605216052260540605456060060605611056110761108
61120611406115061151611546115661210612506130461305
61312613136131461315613206132161333613406134361345
61440614506145861460614806149061500615016151061512
61514615166151861519615206152161522615246152661530
61531615336153461535615366153761538615396154061541
61542615436154461545615466154861550615526155661557
61558615596156361564615666156761570615716157561580
61581615826158361584615856158661590615916159261595
61596615976159861600616016160561606616076160861609
61610616126161361615616166161861619616806168261684
61686616906169261700617026170361705617086171061711
61735617506175161760618606186361864618676186861870
62005620106210062116621176212062121621406214162142
62143621456214662147621806219062192622006220162220
62223622566225863050630516307763078630816308263085
63086630876308863090630916310163102631036317063172
63173631806318263185631906319463195631966319763200
63250632516325263265632666326863270632716327263273
63275632766327763278632806328163282632836328563286
63287632906329563300633016330263303633046330563306
63308637006370263704637066370963710637406475264755
64760648096527369155695356955469950929759299292993