If the meter and disconnect are outside and the main panel is more than 6 ft inside, do I need an additional disconnect?

No. If the outside enclosure at the meter contains the service disconnecting means, the conductors running from it into the building are feeders, not service conductors, and NEC 2023 does not require a second disconnect at the interior panel no matter how far inside it sits. The 6 foot or nearest point of entrance concern applies to unfused service entrance conductors, and you no longer have any once the disconnect is outside.

Why the distance rule exists

Section 230.70(A)(1) requires the service disconnect to be installed at a readily accessible location either outside the building or inside nearest the point of entrance of the service conductors. The reason is that service entrance conductors on the supply side of the disconnect have no overcurrent protection, so a fault in them cannot be cleared from inside the building. The NEC does not print a numeric distance for nearest the point of entrance, which is why local jurisdictions publish their own limit, often 5 or 6 feet or 10 feet of conductor length. That limit only ever applied to the unprotected run.

With an outdoor disconnect, the conductors entering the building are protected by the overcurrent device in that outdoor enclosure. They can run any distance the voltage drop and the raceway will allow.

What actually changes at the interior panel

The interior panel becomes a subpanel, and that brings the rules people miss. The feeder needs four conductors: two ungrounded, one grounded and one equipment grounding conductor sized per Table 250.122. The neutral and ground bars must be separated at the interior panel, which means removing the main bonding jumper or bonding screw under 408.40 and 250.24(A)(5). The grounding electrode system is connected at the outdoor service disconnect, not at the interior panel.

The interior panel does not need a main breaker if the outdoor device is properly sized, but a main breaker there is common and is never a violation. The panel does need to be readily accessible with the working space required by 110.26(A).

The 2023 emergency disconnect rule

For one and two family dwellings, 230.85 requires an emergency disconnect at a readily accessible outdoor location, marked as an emergency disconnect. An outdoor service disconnect at the meter already satisfies this, which is one of the main reasons the outside disconnect arrangement has become the default on new services and service changes.

Field takeaway

The outdoor disconnect ends the service. Everything past it is a feeder, the interior panel becomes a subpanel with separated neutrals and grounds and a four wire feed, and no additional disconnect is required.