Psychiatric Inpatient Hospitalization - Medicare Advantage

This policy covers psychiatric inpatient hospitalization — 24‑hour structured, intensive hospital care with daily physician (MD/DO) supervision, nursing/treatment team interventions, diagnostic services and psychotherapeutic/medical treatment for individuals with mental illness who cannot be safely or adequately managed at a lower level of care. Coverage is limited to Medicare Part A/Medicare Advantage requirements and applicable MAC LCDs in the member’s jurisdiction and requires medical necessity documentation (including the physician’s reasonable expectation that care will span two midnights) and adherence to CMS billing and review rules; services not reasonable and necessary or unsupported by documentation are not covered.

"Psychiatric inpatient hospitalization provides 24 hours of daily care in a structured, intensive, and secure setting"

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