Billing and Coding: Psychiatric Inpatient Hospitalization

Medicare covers inpatient psychiatric facility (IPF) services as 'active treatment' when care is provided under a physician-developed, individualized treatment or diagnostic plan, is reasonably expected to improve the patient's condition or is for diagnosis, and is supervised and periodically evaluated by a physician (with evaluations documented at least weekly). Therapeutic modalities (psychotherapy, drug therapy, ECT, occupational/recreational/milieu therapies) qualify if prescribed by a physician and expected to result in improvement; primarily diversional activities, physician supervision alone, services in non-general-community hospitals (e.g., prison hospitals), and services lacking required documentation are not considered active treatment for coverage purposes.

"IPF services are 'active treatment' when provided under an individualized treatment or diagnostic plan developed by a physician with appropriate other disciplines based on a thorough evaluation of ..."