New Guidance Attempts to Resolve Confusion Regarding the Removal of TKA from IPO List (AAOS)
On Jan. 8, in a major win for AAOS’ advocacy efforts, the Centers for Medicare & Medicaid Services (CMS) issued unprecedented guidance to help resolve confusion regarding the removal of total knee arthroplasty (TKA) from the Medicare inpatient-only (IPO) list.
The 2018 Medicare Outpatient Prospective Payment System (OPPS) Final Rule included a policy change allowing for payment of TKA procedures in either the hospital inpatient or outpatient setting. Unfortunately, the policy change precipitated considerable confusion and differences in interpretation among various stakeholders. The new guidance, prompted by ongoing communication between CMS and the AAOS Office of Government Relations (OGR), aims to clarify CMS’ intent.
Unintended consequence
TKA was removed from the IPO list effective Jan. 1, 2018. CMS was explicit in stating, “Removal of the TKA procedure from the IPO list does not require the procedure to be performed only on an outpatient basis. Removal of the TKA procedure from the IPO list allows for payment of the procedure in either the inpatient setting or the outpatient settin...
