CurrentBlue Cross Blue Shield - TennesseePolicy N/A

Addendum E — HCPCS/CPT Codes Payable Only as Inpatient Procedures (CY 2025)

List of HCPCS/CPT codes that Blue Cross Blue Shield - Tennessee designates as payable only when performed in an inpatient setting for calendar year 2025; applies to providers billing the payer for these services.

Policy Summary

PayerBlue Cross Blue Shield - Tennessee

PolicyAddendum E — HCPCS/CPT Codes Payable Only as Inpatient Procedures (CY 2025)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionSubmit claims for listed procedure codes as inpatient claims per payer rules.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

CY 2025Policy year

~200+Codes in excerpt (approx)

ManyInpatient-only codes

cardiac/thoracic/vascularSpecialties represented

Inpatient-only Coverage Criteria

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Inpatient-only coverage rule (excerpt)

Codes listed in this Addendum E excerpt are treated as inpatient-only procedures for payment purposes.

Procedure codes listed in the Addendum E excerpt (see code lines in chunks 18-19) are to be submitted and paid only when performed in the inpatient setting.

Claims for these procedure codes should be submitted with the appropriate inpatient facility claim type per payer rules.

Inpatient-only designation (excerpt)

This excerpt provides a list of CPT procedure codes identified for inpatient-only payment; no additional clinical criteria or exclusions are provided in these excerpts.

The Addendum E excerpts (chunks 36, 50, 54) list CPT procedure codes that are designated for inpatient-only payment; the document does not provide additional clinical eligibility criteria or exclusions in these sections.

Inpatient-only payment designation (excerpt)

Procedure codes listed in Addendum E are designated to be paid only when performed in the inpatient setting.

Procedure codes shown in Addendum E (see representative surgical CPT codes in chunks 54 and 56) are designated for payment only when services are performed in an inpatient facility.

Inpatient-only coverage stance

Codes listed in this addendum are identified by CMS as inpatient-only procedures; BlueCross BlueShield of Tennessee references this list for payment determination.

Codes enumerated in the Addendum E segments (chunks 72-89) are identified by CMS as inpatient-only procedures and are referenced by BlueCross BlueShield of Tennessee for payment determination.

The Addendum E list is produced by the Centers for Medicare and Medicaid Services and is subject to change; providers should verify the current CMS inpatient-only list when submitting claims.

Inpatient-only Procedure Codes

Representative inpatient-only surgical CPT codes (excerpt)CPT

33120	Resection of external cardiac tumor
63285	Bx/exc intradural intramed lesion cervical
32100	Exploration of chest
32120	Re-exploration of chest
33130	Resection external cardiac tumor
33140	Heart revascularization (TMR)
33202	Insert epicardial electrode open
33300	Repair of heart wound
33405	Replacement aortic valve open
33510	CABG vein single

1–10 of 20

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Sample inpatient-only CPT codes from Addendum E (this excerpt)CPT

32124	Explore chest free adhesions
32140	Removal of lung lesion(s)
32480	Partial removal of lung
32482	Bilobectomy
32486	Sleeve lobectomy
32505	Wedge resect of lung initial
33361	Replace aortic valve percutaneous
33404	Prepare heart-aorta conduit
33410	Replacement aortic valve open
33505	Repair artery with tunnel

1–10 of 14

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Representative inpatient-only surgical CPT codes (cardiac/ECMO/extract)CPT

33946	ECMO/ECLS initiation artery
33948	ECMO/ECLS daily management artery
33951	ECMO/ECLS insert peripheral cannula
33952	ECMO/ECLS insert peripheral cannula
33971	Aortic circulation assist
33973	Insert balloon device
33976	Implant ventricular device
33980	Remove intracorporeal device
33984	ECMO/ECLS removal peripheral cannula
33985	ECMO/ECLS removal central cannula

Thoracic and cardiac surgery codes (sample)CPT

32100	Exploration of chest
32120	Re-exploration of chest
33120	Resection of external cardiac tumor
33300	Repair of heart wound
33405	Replacement aortic valve open
33510	CABG vein single
33533	CABG arterial single

Spine and neurosurgery codes (sample)CPT

63285	Bx/exc intradural intramed lesion cervical
63286	Bx/exc intradural intramed lesion thoracic
63050	Replace brain cavity shunt - related procedures
61531	Removal of brain lesion - implant brain electrodes

Selected inpatient-only CPT/HCPCS codes (partial list)mixed

C9606	Percutaneous d-e coronary revascularization w/AMI
G0341	Percutaneous islet cell transplant
G0342	Laparoscopy islet cell transplant
G0343	Laparotomy islet cell transplant
G0412	Open treatment iliac spine uni/bil
76984	Intraoperative thoracic aorta ultrasound
76987	Intraoperative epicardial ultrasound

Provider Billing and Verification Actions

Billing Rule

Inpatient-only HCPCS/CPT listing (Addendum E)

Providers: Certain HCPCS/CPT procedures are designated by CMS as inpatient-only (Addendum E) and should be billed as inpatient procedures when performed in the inpatient setting. Billing these codes for outpatient settings may lead to claim denial or payment adjustment. Verify patient status and facility billing guidance before submitting claims.

Refer to Addendum E (Inpatient-only HCPCS/CPT listing) for full code list and short descriptors.
Confirm inpatient admission status before billing any code on Addendum E.
For the latest Addendum E updates, check the CMS website prior to claim submission.

Note

Inpatient-only code listing (Addendum E) — selected excerpts

Excerpted inpatient-only code examples from Addendum E (not exhaustive). Use the official CMS Addendum E for complete, authoritative lists and descriptions.

00176, 00192, 00211, 00214, 00215 — anesthesia codes for craniofacial/airway and skull procedures
00560–00567, 00580 — anesthesia codes for cardiac and cardiothoracic procedures
0075T, 0076T — percutaneous/stent chest vertebral artery procedures (addendum entries)
32100 — Exploration of chest
33971–33997 — Aortic circulation assist / ventricular assist device insertion, removal, replacement procedures
34001, 34051, 34151, 34401 — removal of arterial/venous clots (cardiac/vascular procedures)
44126–44160, 44187–44213, 44227 — enterectomy, colectomy, laparoscopic intestinal/colorectal procedures (selected range)

Documentation Required

Inpatient-only procedure list (excerpt)

Selected procedure-level excerpts (surgical/anesthesia/assist device categories) from Addendum E. This is an excerpt for provider awareness — it is not a comprehensive list. Always consult the CMS Addendum E for the official inpatient-only procedure list and full descriptors.

Anesthesia for pharyngeal, facial bone, cranial, chest and cardiac surgeries: e.g., 00176, 00192, 00211, 00214, 00215, 00474, 00524, 00540, 00542, 00546
Cardiac assist and VAD/ECMO procedures: e.g., 33971–33997, 33979–33984 (insert/remove/replace assist devices; ECMO cannula removal)
Major bowel and colorectal resections and laparoscopic intestinal surgeries: e.g., 44126–44160, 44187–44213, 44227
Vascular thrombectomy/removal procedures: e.g., 34001, 34051, 34151, 34401
Perinatal and neonatal specific imaging/diagnostic codes and select HCPCS (examples listed in Addendum E footer)

Definitions and Section References

HCPCS/CPT codes listed in Addendum E (inv-22)

DefinitionHCPCS/CPT codes listed in Addendum E are those the payer designates as payable only as inpatient procedures.

Examples presentAddendum E includes numerous code lines (e.g., anesthesia, surgical procedure codes) across specialties in the excerpt.

Section listing procedure codes (inv-23)

Section nameAddendum E — section of the policy listing procedure codes designated as inpatient-only for payment.

Example code line32100 — Exploration of chest (listed in Addendum E excerpt).

Instruction to providersProviders should ensure claims for listed codes are submitted as inpatient claims per payer rules.

Inpatient-only procedure (inv-24)

Inpatient-only procedure example33971 — Aortic circulation assist (listed in Addendum E as inpatient-only).

Procedure groupAortic circulation assist and related mechanical circulatory support procedures (several 3397x–3399x codes) are included.

ImplicationThese procedures are payable only when performed in the inpatient setting according to Addendum E.

Open bowel to skin (inv-25)

TermOpen bowel to skin — listed as a heading in Addendum E indicating procedures creating an external bowel stoma are included in the inpatient-only list.

Location in Addendum EAppears as the section header 'Open bowel to skin' in the excerpted list.

Related codesCodes for ileostomy/jejunostomy and colostomy appear under this heading (see chunks 56 and related code groups).

Removal of rectum and colon (inv-26)

TermRemoval of rectum and colon — section heading in Addendum E covering colectomy and proctectomy procedures.

Representative codesExamples include 44150 (removal of colon) and 44126–44128 (enterectomy variants) listed in the Addendum E excerpt.

Payment setting implicationProcedures under this heading are designated inpatient-only for payment purposes per Addendum E.

CMS-produced inpatient-only code list (inv-27)

Origin of listThe inpatient-only code list is produced by the Centers for Medicare & Medicaid Services (CMS).

Change controlCMS may revise the inpatient-only designations; the Addendum E list is subject to those changes.

Provider guidanceFor up-to-date inpatient-only status, providers should verify the current CMS list as noted in Addendum E.