What Happens When 637 Inpatient Procedures Land on 23 APCs?

Splenectomy comes off the Medicare inpatient-only list on January 1.

So do removal of the stomach, reduction of a bowel obstruction, thoracoscopic decortication, and 633 other things a hospital has never been allowed to bill outpatient. 1,438 services sit on the list today. CMS proposes to remove 637 of them for CY 2027, holding the neurological, cardiovascular and transplant families for the final year, and the regulation at 42 CFR 419.22(n) now says the list is gone in its entirety by January 1, 2029.

The topline has been reported everywhere since July. What has not is the file underneath it.

CMS published a public use file naming every one of the 637 codes with its proposed status indicator and APC assignment. We pulled it this run, along with the proposed Addendum A rates, and joined the two.

"Once a procedure stops being inpatient-only, what is it actually worth?"

Where the 637 Actually Land

Not across the OPPS payment range. Into a corner of it.

The 637 codes resolve to 29 distinct APCs, and 598 of them carry an APC at all. Eight groups take 425 of the 637, which is 66.7% of everything moving (chart below).

The accent bar is the one to look at. APC 5341, Level 1 Abdominal/Peritoneal/Biliary, absorbs 111 codes at a proposed $4,145.99.

That is the largest destination on the file, and fourth from the bottom on price.

Across all 598 priced codes the median lands at $4,405.95, the floor at $253.80 (31725, clearance of airways) and the ceiling at $24,438.66 for a single code, 53448, removal and replacement of a urinary sphincter. 109 of the 598 price under $2,000.