Inpatient psychiatric hospital benefit days
Medicare provides a lifetime limit of 190 days of inpatient psychiatric hospital care for each beneficiary. Once all 190 days have been used, Medicare will not provide additional coverage for inpatient care in a freestanding psychiatric hospital.
The 190-day lifetime limit applies only to inpatient psychiatric services furnished in a Medicare-participating freestanding psychiatric hospital. It does not apply to psychiatric care provided in a certified psychiatric unit of an acute care hospital (ACH) or a critical access hospital (CAH).
Note: The 190 psychiatric hospital days are not a separate set of benefit days. They are used in conjunction with the Medicare Part A inpatient hospital benefit days available during a benefit period.
Medicare allows up to 150 inpatient hospital benefit days to be used within a single benefit period (90 regular days plus up to 60 lifetime reserve days). Because psychiatric hospital days are drawn from these inpatient benefit days, a beneficiary cannot use more than 150 psychiatric hospital days during a single benefit period, even though the lifetime psychiatric hospital maximum is 190 days.
To use the remaining 40 psychiatric hospital days (190 lifetime days minus 150 days used in one benefit period), the beneficiary must begin a new benefit period. A new benefit period begins only after the beneficiary has not received inpatient hospital or skilled nursing facility (SNF) care for 60 consecutive days.
When admitting a beneficiary to a freestanding inpatient psychiatric facility (IPF), Medicare coverage is not available if:
- The beneficiary has exhausted their inpatient hospital benefit days for the current benefit period, even if they have remaining psychiatric hospital days available under the 190-day lifetime limit; or
- The beneficiary has remaining inpatient hospital benefit days but has already exhausted the 190-day lifetime psychiatric hospital limit.
Pre-entitlement stays: Time spent in a psychiatric hospital before Medicare entitlement does not count toward the beneficiary's 190-day lifetime psychiatric hospital limit. However, pre-entitlement psychiatric hospital days may reduce the 150 inpatient hospital benefit days available during the beneficiary's first benefit period.
The Common Working File (CWF) tracks benefit periods, inpatient hospital benefit day utilization, and the beneficiary's remaining 190-day lifetime psychiatric hospital benefit days.
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