Psychiatric Partial Hospitalization Programs

Medicare covers psychiatric partial hospitalization when a psychiatrist or qualified physician certifies that an individual with an acute DSM-IV Axis I mental disorder requires a structured, multidisciplinary, medically supervised program to avoid or step-down from inpatient hospitalization, the patient can actively participate, and there is a reasonable expectation of improvement. Programs must provide active multimodal treatment (therapies, diagnostic evaluation, medication management), be available at least 20 hours/week with typical patient participation of ≥4 days/20 hours, document individualized treatment plans and informed consent, and exclude primarily custodial, recreational, vocational, or non-acute chronic services.

"Admission and ongoing need for partial hospitalization must be certified by a psychiatrist or a physician (MD/DO) trained in the diagnosis and treatment of psychiatric illness."