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Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor Contractor Number: 11201 Contractor Type: MAC A

LCD Information

LCD ID Number: L34570 Status: A-Approved LCD Title: Psychiatric Inpatient Hospitalization Geographic Jurisdiction: South Carolina Other Jurisdictions Original Determination Effective Date: 10/01/2015 Original Determination Ending Date: Revision Effective Date: 10/31/2019 Revision End Date: CMS National Coverage Policy: Title XVIII of the Social Security Act, §1862 (a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. Title XVIII of the Social Security Act, §1862(a)(7) excludes routine physical examinations. Title XVIII of the Social Security Act, §1812(a)(1) benefits shall consist of payment entitlement for inpatient hospital services or inpatient critical access hospital services for up to 150 days during any spell of illness minus 1 day for each day of such services in excess of 90 received during any preceding spell of illness. Title XVIII of the Social Security Act, §1812(b)(3) inpatient psychiatric hospital services furnished after a total of 190 days during a lifetime. Title XVIII of the Social Security Act, §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. Title XVIII of the Social Security Act, §§1861(a) and (c) defines the terms “spell of illness” and “inpatient psychiatric hospital services.” Title XVIII of the Social Security Act, §1861(f)(1) the term "psychiatric hospital" means an institution which is primarily engaged in providing, by or under the supervision of a physician, psychiatric services for the diagnosis and treatment of mentally ill persons. 42 CFR §409.62 describes the lifetime maximum on inpatient psychiatric care. 42 CFR §410.32(2)(iii)(A) psychological diagnostic testing. 42 CFR §411.4(b) Special conditions for services furnished to individuals in custody of penal authorities. 42 CFR §412.23(a) excluded hospitals: classifications-psychiatric hospitals. 42 CFR §412.27 Excluded psychiatric units: Additional requirements. 42 CFR §482.61 Condition of participation: Special medical record requirements for psychiatric hospitals. CMS Internet-Only Manual, Pub. 100-01, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 4, §10.9 CMS Internet-Only Manual, Pub. 100-01, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 5, §§20.3, 20.4, 20.5, 20.6, 20.7 CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 2, §§10.1, 20, 30, 30.1, 30.2, 30.2.2.1, 30.3.1, 70 CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 1, §§30.4. 30.5 CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, §§130.1, 130.3, 130.4, 130.6, 130.8 and 160.25 Sorry, you need to login or register to view additional sections of this Medicare policy. *