Inpatient and Long Term Acute Care Hospital Services - Medicare Advantage

Covers inpatient hospital and long-term acute care hospital (LTACH) services for Humana Medicare Advantage members, including medically necessary inpatient care related to invasive procedures, certain dental procedures, psychiatric and substance use disorder inpatient treatment, and other services reasonable and necessary for diagnosis or treatment. Coverage is limited to services that meet Medicare’s requirements (e.g., inpatient admission criteria under 42 CFR 412.3 and the two-midnight benchmark), applicable CMS NCDs/LCDs/LCAs and IOM guidance, and LTACH designation criteria (generally average LOS >25 days); services not meeting Medicare’s reasonable-and-necessary or CMS determinations are not covered.

"References to CPT® codes or other sources are for definitional purposes only and do not imply any right to reimbursement or guarantee of claims payment."

Sign up to see full coverage criteria, indications, and limitations.