The Demise of the Inpatient-Only List Begins

by  Ronald Hirsch, MD FACP CHCQM CHRI
Nov 25th, 2025

It finally happened!

The Centers for Medicare & Medicaid Services (CMS) finally released the 2026 Outpatient Prospective Payment Final Rule on Friday at 4:15 pm, delaying my Friday night dinner out with my wife by several hours.

And the final rule really had no surprises.

Of course I went right to the section on the changes to the Two-Midnight rule to see what CMS did. As expected, CMS went ahead and finalized the plan to eliminate the inpatient only list over the next three years just as they proposed with the removal of 285 musculoskeletal-related surgeries and several miscellaneous procedures.

CMS also finalized their proposal to greatly expand the number of procedures allowed at ambulatory surgery centers (ASCs) by adding 560 procedures to the covered procedure list including procedures such as tracheostomy, mediastinoscopy, laparoscopic radical prostatectomy, many cardiology and electrophysiology procedures, and of course all the musculoskeletal procedures.

Now as I have mentioned in the past, I did send CMS many questions about their proposed rule. And sadly they did not provide any great answers. But let me review some of their clarifications that are pertinent to listeners.

... Continue reading the article at RACmonitor →

This article originally published on November 25, 2025 by RACmonitor.

About Ronald Hirsch, MD FACP CHCQM CHRI

Ronald Hirsch, MD, is vice president of the Regulations and Education Group at R1 Physician Advisory Services. Dr. Hirsch’s career in medicine includes many clinical leadership roles at healthcare organizations ranging from acute-care hospitals and home health agencies to long-term care facilities and group medical practices. In addition to serving as a medical director of case management and medical necessity reviewer throughout his career, Dr. Hirsch has delivered numerous peer lectures on case management best practices and is a published author on the topic. He is a member of the Advisory Board of the American College of Physician Advisors, and the National Association of Healthcare Revenue Integrity, a member of the American Case Management Association, and a Fellow of the American College of Physicians. Dr. Hirsch is a member of the RACmonitor editorial board and is regular panelist on Monitor Mondays. The opinions expressed are those of the author and do not necessarily reflect the views, policies, or opinions of R1 RCM, Inc. or R1 Physician Advisory Services (R1 PAS).