150 North Wacker Drive
Suite 1870
Chicago, IL 60606
847-381-5465 Phone
847-381-4606 Fax

User Information

Create New Account

Lost Password


Quick Links

LCDs and LCAs
by Contractor

PLA Codes

Laboratory Fee Schedule


Physician Fee Schedule


OPPS Fee Schedule


ASC Fee Schedule


APC Codes


DRG Codes


ASP Drug Pricing Files

April 2022
January 2022

CMS Transmittals

CodeMap® LCD-L33624


Printer Friendly Version

LCD for Psychiatric Inpatient Hospitalization (L33624)
See related Articles:
A56865-Billing and Coding: Psychiatric Inpatient Hospitalization

Contractor Information

Contractor Name: National Government Services, Inc. - Full list of policies of this Medicare Contractor

Contractor Number: 14412

Contractor Type: MAC B

LCD Information

LCD ID Number: L33624 Status: A-Approved

LCD Title: Psychiatric Inpatient Hospitalization

Geographic Jurisdiction: Rhode Island Other Jurisdictions

Original Determination Effective Date: 10/01/2015

Original Determination Ending Date:

Revision Effective Date: 11/14/2019

Revision End Date:

CMS National Coverage Policy:

Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following Centers for Medicare and Medicaid Services (CMS) sources:

Title XVIII of the Social Security Act (SSA):

Section 1812(a)(1) Inpatient hospital services defined.

Section 1812(b)(3) Lifetime limit of 190 days for inpatient psychiatric benefit days.

Section 1814(4) Medical Records document that services were furnished while the individual was receiving intensive treatment, admission and related services for a diagnostic study, or equivalent services requirement.

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Section 1835(a) Physician certification as a requirement.

Section 1861(a), 1861(c), and 1861(f) "Spell of illness", "inpatient psychiatric hospital services", "psychiatric hospital", "medical and other health services" defined.

Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Code of Federal Regulations:

42 CFR Section 409.62 describes the lifetime maximum on inpatient psychiatric care.

42 CFR Section 410.32 indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements).

42 CFR Section 411.4(a) states that the Medicare Program does not pay for services if the beneficiary has no legal obligation to pay.

42 CFR Section 411.8(a) states that the Medicare Program does not pay for services if the services are paid for directly or indirectly by a governmental entity.

CMS Publications:

CMS Publication 100-01, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 4:

    10 Certification and Recertification by Physicians for Hospital Services - General
    10.1 Failure to Certify or Recertify for Hospital Services
    10.2 Who May Sign Certification or Recertification
    10.4 Inpatient Hospital Services Certification and Recertification
    10.5 Selection by Hospital of Format and Method for Obtaining Statement
    10.9 Inpatient Psychiatric Facility Hospital Services Certification and Recertification
    20.2 Timing for Certification and Recertification for a Beneficiary Admitted Before Entitlement

CMS Publication 100-01, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 5:

    20.3 Psychiatric Hospital
    20.4 Certification of Parts of Institutions as a Psychiatric Hospital
    20.5 Part of a Psychiatric Institution as a Psychiatric Hospital
    20.6 General Hospital Facility of Psychiatric Hospital
    20.7 Part of a General Hospital as a Psychiatric Hospital

CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 2

    10 Inpatient Psychiatric Facility Services
    10.1 Background
    10.2 Statutory Requirements
    10.3 Affected Medicare Providers
    20 Admission Requirements
    30 Medical Records Requirements
    30.1 Development of Assessment/Diagnostic Data
    30.2 Psychiatric Evaluation
    30.2.1 Certification and Recertification Requirements Certification Recertification
    30.2.2 Active Treatment Principles for Evaluating a Period of Active Treatment
    30.2.3 Services Supervised and Evaluated by a Physician
    30.3 Treatment Plan
    30.3.1 Individualized Treatment or Diagnostic Plan
    30.3.2 Services Expected to Improve the Condition or for Purpose of Diagnosis
    30.4 Recording Progress
    30.5 Discharge Planning and Discharge Summary
    40 Personnel Requirements
    40.1 Director of Inpatient Psychiatric Services; Medical Staff
    40.2 Nursing Services
    50 Psychological Services
    60 Social Services
    70 Therapeutic Activities
    80 Benefit Application
    90 Benefits Exhaust

CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 4:

    10 Inpatient Psychiatric Benefit Days Reduction
    10.1 Patient Status on Day of Entitlement
    10.2 Institution's Status in Determining Days Deducted
    20 Days of Admission, Discharge, and Leave
    30 Reduction for Psychiatric Services in General Hospitals
    40 Determining Days Available
    50 Inpatient Psychiatric Hospital Services – Lifetime Limitation

CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 16:

    50.3.1Application of Exclusion to State and Local Government Providers

CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1:

    30.4 Electrosleep Therapy
    30.5 Transcendental Meditation
    70.1 Consultations with a Beneficiary's Family and Associates
    130.1 Inpatient Hospital Stays for the Treatment of Alcoholism
    130.3 Chemical Aversion Therapy for Treatment of Alcoholism
    130.4 Electrical Aversion Therapy for Treatment of Alcoholism (Electroversion Therapy, Electro-shock Therapy, Noxious Faradic Stimulation)
    130.6 Treatment of Drug Abuse (Chemical Dependency)
    130.8 Hemodialysis for Treatment of Schizophrenia
    160.25 Multiple Electroconvulsive therapy (MECT)
    230.4 Diagnosis and Treatment of Impotence

CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 1:

    10.4 Claims Submitted for Items or Services Furnished to Medicare Beneficiaries in State or Local Custody Under a Penal Authority

CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 3:

    30.1 Requirements for CAH Services, CAH Skilled Nursing Care Services and Distinct Part Units

CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 29:

    230 Where to Appeal and Initial Determinations

Sorry, you need to login or register to view additional sections of this Medicare policy.

All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.

06/26/2022 04:01:03

CodeMap® is a Registered Trademark of Wheaton Partners, LLC.