Published 7/22/2021

AAOS on IPO Elimination Reversal in 2022 CMS Outpatient Rule

WASHINGTON, D.C. (July 22, 2021)American Association of Orthopaedic Surgeons (AAOS) President Daniel K. Guy, MD, FAAOS, issued the following statement in response to the newly released Calendar Year (CY) 2022 Hospital Outpatient Prospective Payment System (OPPS) proposed rule. Most notably, the Centers for Medicare & Medicaid Services (CMS) is proposing to halt the elimination of the Inpatient Only (IPO) list and place the 298 services that were previously removed back onto the list beginning in CY 2022.  

“AAOS is encouraged to hear that CMS has heeded the patient safety concerns of the physician community regarding the abrupt elimination of the Inpatient Only (IPO) List. We continue to support the removal of procedures which have been proven to be done safely in the outpatient setting; however, there is much work left to be done to clarify what these changes mean in order to avoid widespread confusion and unintended consequences for patient care. Orthopaedic surgeons know firsthand from their experience with total knee arthroplasty removal in 2018, total hip arthroplasty in 2020, and then the removal of all musculoskeletal procedures in 2021 how challenging such a dramatic shift can be to safe and timely musculoskeletal care.  

“Now as the agency reassess how it will evaluate future procedures for removal and the longer-term plan for the IPO, it should place more emphasis on physicians leading those decisions and prioritize the value of patient choice. CMS must also be careful to avoid creating new regulatory barriers to determining the appropriate setting of care as an overcorrection to the policy reversal—especially now after the country has benefited from such flexibilities and individualized medicine during the COVID-19 pandemic.

“Transparency around these changes and input from the medical community are critical to the successful implementation of the rule. We look forward to commenting on the proposal in greater detail and offering our formal comments later this year on behalf of the musculoskeletal community.”


About the AAOS
The American Association of Orthopaedic Surgeons (AAOS) Office of Government Relations promotes and advocates the viewpoint of the orthopaedic community before federal and state legislative, regulatory, and executive agencies. Based in Washington, DC, with additional staff in the Academy’s headquarters in Rosemont, Illinois, the Office of Government Relations identifies, analyzes, and directs all health policy activities and initiatives to position the AAOS as the trusted leaders in advancing musculoskeletal health. For more information on all AAOS advocacy efforts, visit

Contact AAOS Media Relations 

Kristen Coultas