Psychiatric Inpatient Hospitalization

Medicare covers inpatient psychiatric hospitalization when a patient requires active, physician‑supervised treatment in an intensive 24‑hour setting because outpatient care is inadequate or unsafe. Indications include imminent risk to self or others, command hallucinations, severe cognitive or functional impairment, failure of outpatient treatment, or psychiatric comorbidity in dementia, and coverage is contingent on physician certification/recertification and documented individualized treatment plans and consent. Services that are custodial, recreational, aimed solely at maintenance without acute exacerbation, or otherwise unsupported by the medical record are excluded.

"Medicare patients must be under the care of a physician knowledgeable about the patient who certifies and recertifies the need for inpatient psychiatric hospitalization."

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