Inpatient Psychiatric Hospital Services

The following requirements must be met for Medicare to pay for inpatient psychiatric hospital services:

  • Patient must be furnished active psychiatric treatment that can reasonably be expected to improve his/her condition;
  • Services must be furnished while patient is receiving either active psychiatric treatment or admission and related services necessary for diagnostic treatment;
  • A physician must provide certification at time of admission or as soon thereafter as is reasonable and practicable that patient needs, on a daily basis, active inpatient treatment furnished directly by or requiring the supervision of Inpatient Psychiatric Facility (IPF) personnel; and
  • A physician must provide first re-certification as of 12th day of hospitalization and subsequent re-certifications at intervals established by utilization review committee (on a case-by-case basis, if it so chooses), but no less than every 30 days that the patient continues to need, on a daily basis, active inpatient treatment furnished directly by or requiring supervision of IPF personnel.

Patients who are treated for psychiatric conditions in specialty facilities are covered for 90 days of care per illness with a 60-day lifetime reserve and for 190 days of care in freestanding psychiatric hospitals.
 

Last Updated May 07, 2018