LCD for Psychiatric Inpatient Hospitalization (L13725)

 

Contractor Information

Contractor Name 

BlueCross BlueShield of Tennessee (Riverbend Government Benefits Administrator) 

Contractor Number 

00390 

Contractor Type 

FI 

 

LCD Information

LCD ID Number 

L13725 

 

LCD Title 

Psychiatric Inpatient Hospitalization 

 

Contractor's Determination Number 

L13725 

 

AMA CPT / ADA CDT Copyright Statement 

CPT codes, descriptions and other data only are copyright 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.  

 

CMS National Coverage Policy 

Unless otherwise specified, italicized text represents quotation from one or more of the following Centers for Medicare and Medicaid Services (CMS) sources:

Title XVIII of the Social Security Act (SSA):

Section 1812(a)(1) Inpatient hospital services defined.

Section 1812(b)(3) Lifetime limit of 190 days for inpatient psychiatric benefit days.

Section 1814(4) Medical Records document that services were furnished while the individual was receiving intensive treatment, admission and related services for a diagnostic study, or equivalent services requirement.

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Section 1835(a) Physician certification as a requirement.

Section 1861(a), 1861(c), and 1861(f) "Spell of illness", "inpatient psychiatric hospital services", "psychiatric hospital", "medical and other health services" defined.

Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Code of Federal Regulations:

42 CFR Section 409.62 describes the lifetime maximum on inpatient psychiatric care.

42 CFR Section 410.32 indicates that diagnostic tests may only be ordered by treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements).

CMS Publications:

CMS Publication 6, Medicare Coverage Issues Manual (CIM):

35-14 Consultations with a Beneficiary’s Family and Associates
35-18 Electrosleep Therapy – Not Covered
35-22 Inpatient Hospital Stays for the Treatment of Alcoholism
35-22.2 Treatment of Drug Abuse (Chemical Dependency)
35-23 Chemical Aversion Therapy for Treatment of Alcoholism
35-23.1 Electrical Aversion Therapy for Treatment of Alcoholism (Electroversion Therapy, Electro-shock Therapy, Noxious Faradic Stimulation)
35-24 Diagnosis and Treatment of Impotence
35-51 Hemodialysis for Treatment of Schizophrenia – Not Covered
35-92 Transcendental Meditation – Not Covered
35-103 Multiple-Seizure Electroconvulsive therapy (MECT) – Not Covered

CMS Pub 100-1, 5-§20.3 Definition of Psychiatric Hospital
CMS Pub 100-1, 5-§20.5 Part of a Psychiatric Institution as a Psychiatric Hospital
CMS Pub 100-1, 5-§20.6 General Hospital Facility of Psychiatric Hospital
CMS Pub 100-1, 5-§20.7 Part of a General Hospital as a Psychiatric Hospital
CMS Pub 100-2, 2-§20 Active Treatment in Psychiatric Hospitals
CMS Pub 100-2, 2-§40 Nonpsychiatric Care in a Psychiatric Hospital
CMS Pub 100-1, 4-§10 Inpatient Psychiatric Benefit Days Reduction
CMS Pub 100-1, 4-§10.1 Patient Status on Day of Entitlement
CMS Pub 100-1, 4-§10.2 Institution’s Status in Determining Days Deducted
CMS Pub 100-1, 4-§20 Days of Admission, Discharge, and Leave
CMS Pub 100-1, 4-§30 Reduction for psychiatric Services in General Hospitals
CMS Pub 100-1, 4-§40 Determining Days Available-Date of Entitlement After 1967
CMS Pub 100-1, 4-§50 Inpatient Psychiatric Hospital Services-Lifetime Limitation
CMS Pub 100-1, 4-§10 Certification and Recertification of Physicians—General
CMS Pub 100-1, 4-§10.1 Failure to Certify or Recertify
CMS Pub 100-1, 4-§10.2 Who May Sign Certification or Recertification
CMS Pub 100-1, 4-§10.4 Inpatient Hospital Services Certification and Recertification
CMS Pub 100-1, 4-§10.8 Timing of Certifications and Recertifications
CMS Pub 100-1, 4-§10.9 Inpatient Psychiatric Hospital Services Certification and Recertification
CMS Pub 100-1, 4-§20.2 Timing of Certification and Recertification for Beneficiary Admitted Before Entitlement

CMS Pub 100-2, 2-§10 Covered Inpatient Psychiatric Hospital Services 

 

Primary Geographic Jurisdiction 

New Jersey
Tennessee
 

 

Secondary Geographic Jurisdiction 

Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
North Carolina
North Dakota
Nebraska
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
 

 

Oversight Region 

Region IV
 

 

 

Original Determination Effective Date 

For services performed on or after 12/06/2003  

 

Original Determination Ending Date 

 

 

Revision Effective Date 

For services performed on or after 12/15/2005  

 

Revision Ending Date 

 

 

Indications and Limitations of Coverage and/or Medical Necessity 

Inpatient psychiatric hospitalization provides twenty four (24) hours of daily care in a structured, intensive, and secure setting for patients who cannot be safely and/or adequately managed at a lower level of care. This setting provides daily physician (MD/DO) supervision, twenty-four (24) hour nursing/treatment team evaluation and observation, diagnostic services, and psychotherapeutic and medical interventions.

Inpatient psychiatric care may be delivered in a Psychiatric Hospital, a Psychiatric Hospital Acute Care Unit within a Psychiatric Institution, or a Psychiatric Inpatient Unit within a General Hospital as defined in CMS Pub 100-1, 5-§20.3, 100-1, 5-§20.5 and 100-1, 5-§20.7. This LCD addresses psychiatric care in a DRG-excluded unit; the review of DRG based claims from non-excluded psychiatric units of acute care hospitals is the responsibility of the QIO and is not within the purview of the Fiscal Intermediary.

Medicare patients admitted to inpatient psychiatric hospitalization must be under the care of a physician who is knowledgeable about the patient. The physician must certify/recertify (see “Documentation Requirements” section) the need for inpatient psychiatric hospitalization. The patient must require “active treatment” of his/her psychiatric disorder. The patient or legal guardian must provide written informed consent for inpatient psychiatric hospitalization.

Admission Criteria (Physician Decision to Admit):



An admission is not considered medically necessary until medical necessity is established by the admitting physician. Since a delay in performing the medical (psychiatric) history and physical examination beyond the initial 24 hours is typically a matter of physician convenience, if the admitting physician at the time of the initial H&P does not establish a need for an inpatient stay, the entire stay will usually be considered appropriate for outpatient observation and an inpatient claim will be denied as not medically necessary. The initial evaluation should therefore be performed within the first 24 hours of the stay if there is any doubt in the mind of the attending physician as to the necessity for the inpatient level of care.

Admission Criteria (Intensity of Service):



The patient must require intensive, comprehensive, multimodal treatment including 24 hours per day of medical supervision and coordination because of a mental disorder. The need for 24 hours of supervision may be due to the need for patient safety, psychiatric diagnostic evaluation, potential severe side effects of psychotropic medication associated with medical or psychiatric co-morbidities, or evaluation of behaviors consistent with an acute psychiatric disorder for which a medical cause has not been ruled out.

The acute psychiatric condition being evaluated or treated by inpatient psychiatric hospitalization must require active treatment, including a combination of services such as intensive nursing and medical intervention, psychotherapy, occupational and activity therapy. Patients must require inpatient psychiatric hospitalization services at levels of intensity and frequency exceeding what may be rendered in an outpatient setting, including psychiatric partial hospitalization. There must be evidence of failure at, or inability to benefit from, a less intensive, outpatient program, or other evidence that a less comprehensive program would be unsafe or medically unsound. Claims for care delivered at an inappropriate level of intensity will be denied.

Admission Criteria (Severity of Illness):



A medically appropriate inpatient admission should typically meet one or more of the following criteria:


1. Threat to self requiring 24-hour professional observation


a.) suicidal ideation or gesture within 48 hours prior to admission (plan, means and intent)

b.) self mutilation (actual or threatened) within 48 hours prior to admission

c.) chronic and continuing self destructive behavior (e.g., bulemic behaviors, substance abuse) that poses a significant and/or immediate threat to life, limb, or bodily function.


2. Threat to others requiring 24-hour professional observation:


a.) assaultive behavior threatening others within 48 hours prior to admission.

b.) significant verbal threat to the safety of others within 48 hours prior to admission.


3. Command hallucinations directing harm to self or others where there is the risk of the patient taking action on them.

4. Acute disorder/bizarre behavior or psychomotor agitation or retardation that interferes with the activities of daily living (ADLs) so that the patient cannot function at a less intensive level of care during evaluation and treatment.

5. Cognitive impairment (disorientation or memory loss) due to an acute Axis I disorder that endangers the welfare of the patient or others.

6. A mental disorder causing major disability in social, interpersonal, occupational, and/or educational functioning that is leading to dangerous or life-threatening functioning, and that can only be addressed in an acute inpatient setting.

7. A mental disorder that causes an inability to maintain adequate nutrition or self-care, and family/community/social support cannot provide reliable, essential care, so that the patient cannot function at a less intensive level of care during evaluation and treatment.

8. Failure of outpatient psychiatric treatment so that the beneficiary requires 24-hour professional observation and care. Reasons for the failure of outpatient treatment could include:


a.) Increasing severity of psychiatric symptoms;

b.) Noncompliance with medication regimen due to the severity of psychiatric symptoms;

c.) Inadequate clinical response to psychotropic medications;

d.) Due to the severity of psychiatric symptoms, the patient is unable to participate in an outpatient psychiatric treatment program.



An inpatient admission may be medically appropriate in circumstance not listed above; however those occasions are uncommon and should be examined carefully to ensure that less intensive settings are not reasonable. For all symptom sets or diagnoses, the severity and acuity of symptoms and the likelihood of response to treatment, combined with the requirement for an intensive, 24-hour level of care, are the significant factors in determining the necessity of inpatient psychiatric treatment.

Active Treatment:



The italicized text in this portion of the LCD is quoted verbatim from CMS Pub 100-2, 2-§20:

For services in a hospital to be designated as "active treatment," they must be:


(a) provided under an individualized treatment or diagnostic plan,

(b) reasonably expected to improve the patient's condition or for the purpose of diagnosis, and

(c) supervised and evaluated by a physician.


Such factors as diagnosis, length of hospitalization, and the degree of functional limitation, while useful as general indicators of the kind of care most likely being furnished in a given situation, are not controlling in deciding whether the care was active treatment. The following is a discussion of each element of the above definition of active treatment:



l. Individualized Treatment or Diagnostic Plan.-- The services must be provided in accordance with an individualized program of treatment or diagnosis developed by a physician in conjunction with staff members of appropriate other disciplines on the basis of a thorough evaluation of the patient's restorative needs and potentialities. Thus, an isolated service, e.g., a single session with a psychiatrist, or a routine laboratory test not furnished under a planned program of therapy or diagnosis would not constitute active treatment, even though the service was therapeutic or diagnostic in nature. The plan of treatment must be recorded in the patient's medical record in accordance with section 405.1037(a)(8) of the regulations on Conditions of Participation for Hospitals.

2. Services Expected to Improve the Condition or for Purpose of Diagnosis.--The services must be reasonably expected to improve the patient's condition or must be for the purpose of diagnostic study. It is not necessary that a course of therapy have as its goal the restoration of the patient to a level which would permit discharge from the institution although the treatment must, at a minimum, be designed both to reduce or control the patient's psychotic or neurotic symptoms which necessitated hospitalization and improve the patient's level of functioning.

The kinds of services which meet the above requirements would include not only psychotherapy, drug therapy, and shock therapy, but also such adjunctive therapies as occupational therapy, recreational therapy, and milieu therapy, provided the adjunctive therapeutic services are expected to result in improvement (as defined above) in the patient's condition. If, however, the only activities prescribed for the patient are primarily diversional in nature, i.e., to provide some social or recreational outlet for the patient, it would [not] be regarded as treatment to improve the patient's condition. In many large hospitals these adjunctive services are present and part of the life experience of every patient. In a case where milieu therapy (or one of the other adjunctive therapies) is involved, it is particularly important that this therapy be a planned program for the particular patient and not one where life in the hospital is designated as milieu therapy.

In accordance with the above definition of "improvement," the administration of antidepressant or tranquilizing drugs which are expected to significantly alleviate a patient's psychotic or neurotic symptoms would be termed active treatment (assuming that the other elements of the definition are met). However, the administration of a drug or drugs does not of itself necessarily constitute active treatment. Thus, the use of mild tranquilizers or sedatives solely for the purpose of relieving anxiety or insomnia would not constitute active treatment.

3. Services Supervised and Evaluated by a Physician.-- Physician participation in the services is an essential ingredient of active treatment. The services of qualified individuals other than physicians, e.g., social workers, occupational therapists, group therapists, attendants, etc., must be prescribed and directed by a physician to meet the specific needs of the individual. In short, the physician must serve as a source of information and guidance for all members of the therapeutic team who work directly with the patient in various roles. It is the responsibility of the physician to periodically evaluate the therapeutic program and determine the extent to which treatment goals are being realized and whether changes in direction or emphasis are needed. Such evaluation should be made on the basis of periodic consultations and conferences with therapists, reviews of the patient's medical record, and regularly scheduled patient interviews--at least once a week.
(Although it is CMS’ requirement that the physician see the patient at least once per week, this is a dated reference, referring to a time when patients were hospitalized for long periods of time. The current standard of practice is that the physician usually sees the patient at least five times per week, and Riverbend defines that as a local requirement.)

Although in an institutional setting the services of a physician may be readily available, the general pattern is for the physician to visit the patient only periodically, delegating to nursing personnel the responsibility for intensive observation of patients, where it is necessary. Such periodic visits to a patient do not in themselves constitute active treatment. Conversely, when the physician periodically evaluates the therapeutic program to determine the extent to which treatment goals are being realized and whether changes in direction or emphasis are needed based on consultations and conferences with therapists, review of the patient's progress as recorded on his medical record and his periodic conversations with the patient, active treatment would be indicated. The treatment furnished the patient should be documented in the medical record in such a manner and with such frequency as to provide a full picture of the therapy administered as well as an assessment of the patient's reaction to it. (See section 405.1037(a)(9) and (10) of the regulations on Conditions of Participation for Hospitals.)

A finding that a patient is not receiving active treatment will not in itself preclude payment for physicians' services under Part B. As long as the professional services rendered by the physician are reasonable and necessary for the care of the patient, such services would be reimbursable under the medical insurance program.



B. Principles for Evaluating a Period of Active Treatment.--As indicated, the period of time covered by the physician's certification is referred to as a "period of active treatment." This period should include all days on which inpatient psychiatric hospital services were provided because of the individual's need for active treatment--not just the days on which specific therapeutic or diagnostic services were rendered. For example, a patient's program of treatment may necessitate the discontinuance of therapy for a period of time or it may include a period of observation, either in preparation for or as a followup to therapy, while only maintenance or protective services are furnished. If such periods were essential to the overall treatment plan, they would be regarded as part of the period of active treatment.

The fact that a patient is under the supervision of a physician does not necessarily mean that he is getting active treatment. For example, medical supervision of a patient may be necessary to assure the early detection of significant changes in his condition; however, in the absence of a specific program of therapy designed to effect improvement, a finding that the patient is receiving active treatment would be precluded.

The program's definition of active treatment does not automatically exclude from coverage services rendered to patients who have conditions which ordinarily result in progressive physical and/or mental deterioration. Although patients with such diagnoses will most commonly be receiving custodial care, they may also receive services which meet the program's definition of active treatment. This might be the case, for example, where a patient with Alzheimer's or Pick's disease received services designed to alleviate the effects of paralysis, epileptic seizures, or some other neurological symptom, or where a patient in the terminal stages of any disease received life- supportive care. A period of hospitalization during which services of this kind were furnished would be regarded as a period of active treatment.
(CMS Pub 100-2, 2-§20) Note, however, that to qualify for inpatient psychiatric care, it is the need for inpatient psychiatric services that determines the medical appropriateness of the stay in an excluded psychiatric unit. A medical condition, be it an indolent refractory condition such as Alzheimer’s or the terminal stages of a fulminant disease, is not medically appropriate for an inpatient psychiatric stay when the psychiatric condition is a small part of the need for services. These patients may be appropriate for acute or long term inpatient or SNF care with psychiatric support in any of those environments. Conversely, a patient with psychiatric disease may have medical comorbidities that would render the psychiatric care ineffective in a less intensive setting; such a patient is medically appropriate for an inpatient psychiatric stay. It is also true that, whereas the patient must have a psychiatric diagnosis that is amenable to treatment, it is not necessary that the medical prognosis must be favorable as well.

Discharge Criteria (Intensity of Service):



Patients in inpatient psychiatric care may be discharged by stepping down to a less intensive level of outpatient care. Stepping down to a less intensive level of service than inpatient hospitalization would be considered when patients no longer require 24-hour observation for safety, diagnostic evaluation, or treatment as described above. These patients would become outpatients, either receiving psychiatric partial hospitalization or individual outpatient mental health services, rendered and billed by appropriate providers.

Discharge Criteria (Severity of Illness):



Patients whose clinical condition improves or stabilizes and who do not still require 24-hour observation available in an inpatient psychiatric unit should be stepped down to outpatient care. Patients whose Global Assessment of Functioning is above 30 would usually be appropriate for discharge to a less intense level of care. Patients unwilling or unable to participate in active treatment of their psychiatric condition would also be appropriate for discharge.

Qualified Providers:



Inpatient psychiatric diagnostic and treatment services rendered to Medicare beneficiaries must be provided by individuals licensed or otherwise authorized by the state in which they practice, to render such services. Non-physician practitioners, licensed or authorized by the state, may perform duties within their scope of practice, such as individual and/or group psychotherapy, family counseling, occupational therapy, and diagnostic services. Providers of inpatient psychiatric services may include:



Physicians:


1. Medical Doctor (MD) (See Title XVIII of the Social Security Act, Section 1861[r].)

2. Doctor of Osteopathy (DO) (See Title XVIII of the Social Security Act, Section 1861[r].)



Nonphysician Clinical Practitioners:


1. Clinical Psychologists (See Title XVIII of the Social Security Act, Sections 1861[s][2][M] and 1861[hh][2][ii].)

2. Clinical Nurse Specialists (CNSs), or other registered nurses with appropriate mental health training and/or experience (See Title XVIII of the Social Security Act, Sections 1861[s][2][K][ii] and 1861[aa][5][B].)

3. Licensed/certified clinical social workers (CSWs), masters-prepared social workers with additional clinical training AND licensure or state certification (See Title XVIII of the Social Security Act, Sections 1861[s][2][N] and 1861[hh][1].)

4. Occupational Therapists (See Title XVIII of the Social Security Act, Section 1861[g] and 42 CFR Sections 440.110 and 484.4.)



Other Providers Licensed or Otherwise Authorized by the State:


1. Marriage and Family Therapists (MFTs), as allowed by state law.

2. Registered Therapists and Certified Alcohol and Drug Counselors, as allowed by state law.

3. Recreational Therapists, as allowed by state law.

4. Registered pharmacists who may provide individual medication counseling and periodic educational groups

5. Other licensed or certified mental health practitioners whose scope of practice requires a specific level of supervision (e.g., Psychological Assistants, MFT interns and non-licensed/certified Masters in Social Work may provide services within the limits of state scope of practice, licensure, and regulations).



Other Comments:


1. Psychological Interns with less than a Master's Degree are not considered a provider of service.

2. An appropriately licensed supervisor must observe and provide one-on-one, in-person, supervision for at least one hour per week for non-licensed/certified MSWs, MFT interns, and psychological assistants. If state-mandated supervision exceeds this level, the highest level of supervision is required. Such supervision need not occur on the inpatient psychiatric unit but must be documented and documentation must be maintained in the hospital and available for inspection upon request by Medicare or submitted to Medicare when requested.



NOTE: Limits of local, state or federal scope of practice acts, legislation, and licensure regulations apply to all practitioners within an inpatient psychiatric treatment unit. In all cases, the most restrictive limit shall apply (e.g., who may or may not perform individual or group psychotherapy).

A claim that does not fulfill the coverage requirements described above may be given individual consideration based on review of all pertinent medical information.


Reasons for Denial:

1. Failure to provide documentation to support the necessity of test(s) or treatment(s) may result in denial of claims or services under Sections 1862(a)(1)(A) and 1833(e) of the Title XVIII of the Social Security Act. This includes medical records:


a. that do not support the reasonableness and necessity of service(s) furnished;

b. in which the documentation is illegible; or

c. where medical necessity for inpatient psychiatric services is not appropriately certified.



2. The following services do not represent reasonable and medically necessary inpatient psychiatric services and coverage is excluded under Title XVIII of the Social Security Act, Section 1862(a)(1)(A):


a. Services which are primarily social, recreational or diversion activities, or custodial or respite care;

b. Services attempting to maintain psychiatric wellness for the chronically mentally ill;

c. Treatment of chronic conditions without acute exacerbation;

d. Vocational training;

e. Medical records that fail to document the required level of physician supervision and treatment planning process;

f. Electrosleep therapy (CIM 35-18);

g. Electrical Aversion Therapy for treatment of alcoholism (CIM 35-23.1);

h. Hemodialysis for the treatment of schizophrenia (CIM 35-51);

i. Transcendental Meditation (CIM 35-92);

j. Multiple Electroconvulsive Therapy (MECT) (CIM 35-103).



3. It is not reasonable and medically necessary to provide inpatient psychiatric hospital services to the following types of patients, and coverage is excluded under Title XVIII of the Social Security Act, Section 1862(a)(1)(A):


a. Patients who require primarily social, custodial, recreational, or respite care;

b. Patients whose clinical acuity requires less than twenty-four (24) hours of supervised care per day;

c. Patients who have met the criteria for discharge from inpatient hospitalization;

d. Patients whose symptoms are the result of a medical condition that requires a medical/surgical setting for appropriate treatment;

e. Patients whose primary problem is a physical health problem without a concurrent major psychiatric episode;

f. Patients with alcohol or substance abuse problems who do not have a combined need for "active treatment" and psychiatric care that can only be provided in the inpatient hospital setting. (CIM 35-22 & 35-22.2);

g. Patients for whom admission to a psychiatric hospital is being used as an alternative to incarceration.



4. Listing an ICD-9-CM code in the Mental Disorders category (290 - 319) does not assure coverage of the specific service. Coverage criteria specified in this LCD shall be applied to determine appropriate reimbursement.

5. Medicare contractors may automatically deny a claim without any manual review if a national coverage decision or an LCD specifies the circumstances under which a service is denied and those circumstances exist, or the service is specifically excluded from Medicare coverage by statute.

6. When an admission is denied, all services for that date of service related to that admission will also be denied.

Other Comments
This does NOT address the following issues:

1. Life Time Limits and Spell of Illness Limits to psychiatric hospitalization services as defined by the CMS Pub 100-1, 4-§10,100-1, 4-§10,100-1, 4-§10.2, 100-1, 4-§20,100-1, 4-§30, 100-1, 4-§40, and 100-1, 4-§50 and CMS Publication 13, Medicare Intermediary Manual, Sections 100-2, 4-§10-§50. Nothing in this article can be used to either expand or contract those limits; however, coverage may be denied for medical necessity reasons even though the beneficiary has not exhausted the life time limit or spell of illness limit for psychiatric hospitalization services.

2. Notice to Beneficiaries as described in CMS Publication 10, Medicare Hospital Manual, Sections 100-4, 2-§80-§80.3. All requirements related to discharge and coverage notification as described in the Medicare interpretive manuals apply.

3. Psychiatric Advance Directives as defined in 42 CFR Section 482.13(b)(3). All requirements related to Psychiatric Advance Directives must be met as part of the Hospital Conditions of Participation for Patients Rights.

4. Chemical or Physical Restraints, Seclusion, or Behavior Management within a psychiatric plan of care. These issues are addressed extensively in the Hospital Patient's Rights Legislation published in 64 FR 36070, July 2, 1999. All applicable requirements described in this publication must be met.

5. Certification of Facilities as psychiatric hospitals, psychiatric Inpatient Units within a Psychiatric Institution, or Psychiatric Inpatient Units within a General Hospital as defined in CMS Pub 100-1, 5-§20.3, §20.5 and §20.7. All requirements described in the Medicare interpretive manuals apply.

6. Items and Services Furnished, Paid for or Authorized by Governmental Entities as defined by CMS Pub 100-2, 16-§50: Payment may be made for items and services furnished by a participating State or local government hospital, including a psychiatric hospital, which serves the general community. A psychiatric hospital to which patients convicted of crimes are committed involuntarily is considered to be serving the general community if State law provides for voluntary commitment to the institution. However, payment may not be made for services furnished in State or local hospitals which serve only a special category of the population, but do not serve the general community, e.g., prison hospitals.

Notice to beneficiaries requirements apply. See number 2 in the “Other Comments” section above.

 

 

Coverage Topic 

Mental Health Care (Inpatient)
 

 

Coding Information

Bill Type Codes: 

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

 

 

 

Revenue Codes: 

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

 

99999

Not Applicable

 

 

CPT/HCPCS Codes 

Not applicable

XX000

Not Applicable

 

 

ICD-9 Codes that Support Medical Necessity 

The correct use of an ICD-9-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the policy.
Codes not listed below as “ICD-9 Codes That Support Medical Necessity” may be denied. Non-covered diagnosis codes may be covered upon an individual consideration basis with supporting evidence of medical necessity. (Title XVIII of the Social Security Act, Section 1862[a][1][A].) The codes selected are generally those codes that appear in the ICD-9-CM and that are defined in the Diagnostic and Statistical Manual, fourth edition (DSM-IV-TR™).

290.11

PRESENILE DEMENTIA WITH DELIRIUM

290.12

PRESENILE DEMENTIA WITH DELUSIONAL FEATURES

290.13

PRESENILE DEMENTIA WITH DEPRESSIVE FEATURES

290.20

SENILE DEMENTIA WITH DELUSIONAL FEATURES

290.21

SENILE DEMENTIA WITH DEPRESSIVE FEATURES

290.3

SENILE DEMENTIA WITH DELIRIUM

290.41

VASCULAR DEMENTIA, WITH DELIRIUM

290.42

VASCULAR DEMENTIA, WITH DELUSIONS

290.43

VASCULAR DEMENTIA, WITH DEPRESSED MOOD

291.0

ALCOHOL WITHDRAWAL DELIRIUM

291.3

ALCOHOL-INDUCED PSYCHOTIC DISORDER WITH HALLUCINATIONS

291.5

ALCOHOL-INDUCED PSYCHOTIC DISORDER WITH DELUSIONS

291.81

ALCOHOL WITHDRAWAL

291.89

OTHER SPECIFIED ALCOHOL-INDUCED MENTAL DISORDERS

291.9

UNSPECIFIED ALCOHOL-INDUCED MENTAL DISORDERS

292.11

DRUG-INDUCED PSYCHOTIC DISORDER WITH DELUSIONS

292.12

DRUG-INDUCED PSYCHOTIC DISORDER WITH HALLUCINATIONS

292.81

DRUG-INDUCED DELIRIUM

292.84

DRUG-INDUCED MOOD DISORDER

292.89

OTHER SPECIFIED DRUG-INDUCED MENTAL DISORDERS

292.9

UNSPECIFIED DRUG-INDUCED MENTAL DISORDER

293.81 - 293.89

PSYCHOTIC DISORDER WITH DELUSIONS IN CONDITIONS CLASSIFIED ELSEWHERE - OTHER SPECIFIED TRANSIENT MENTAL DISORDERS DUE TO CONDITIONS CLASSIFIED ELSEWHERE, OTHER

293.9

UNSPECIFIED TRANSIENT MENTAL DISORDER IN CONDITIONS CLASSIFIED ELSEWHERE

294.11

DEMENTIA IN CONDITIONS CLASSIFIED ELSEWHERE WITH BEHAVIORAL DISTURBANCE

295.10

DISORGANIZED TYPE SCHIZOPHRENIA UNSPECIFIED STATE

295.20

CATATONIC TYPE SCHIZOPHRENIA UNSPECIFIED STATE

295.30

PARANOID TYPE SCHIZOPHRENIA UNSPECIFIED STATE

295.40

SCHIZOPHRENIFORM DISORDER, UNSPECIFIED

295.70

SCHIZOAFFECTIVE DISORDER, UNSPECIFIED

295.90

UNSPECIFIED TYPE SCHIZOPHRENIA UNSPECIFIED STATE

296.01 - 296.05

BIPOLAR I DISORDER, SINGLE MANIC EPISODE, MILD - BIPOLAR I DISORDER, SINGLE MANIC EPISODE, IN PARTIAL OR UNSPECIFIED REMISSION

296.21 - 296.25

MAJOR DEPRESSIVE AFFECTIVE DISORDER SINGLE EPISODE MILD DEGREE - MAJOR DEPRESSIVE AFFECTIVE DISORDER SINGLE EPISODE IN PARTIAL OR UNSPECIFIED REMISSION

296.31 - 296.35

MAJOR DEPRESSIVE AFFECTIVE DISORDER RECURRENT EPISODE MILD DEGREE - MAJOR DEPRESSIVE AFFECTIVE DISORDER RECURRENT EPISODE IN PARTIAL OR UNSPECIFIED REMISSION

296.41 - 296.45

BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MANIC, MILD - BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MANIC, IN PARTIAL OR UNSPECIFIED REMISSION

296.51 - 296.55

BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) DEPRESSED, MILD - BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) DEPRESSED, IN PARTIAL OR UNSPECIFIED REMISSION

296.61 - 296.65

BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MIXED, MILD - BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MIXED, IN PARTIAL OR UNSPECIFIED REMISSION

296.7

BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) UNSPECIFIED

296.80

BIPOLAR DISORDER, UNSPECIFIED

296.89

OTHER AND UNSPECIFIED BIPOLAR DISORDERS, OTHER

296.90

UNSPECIFIED EPISODIC MOOD DISORDER

297.1

DELUSIONAL DISORDER

297.3

SHARED PSYCHOTIC DISORDER

298.8

OTHER AND UNSPECIFIED REACTIVE PSYCHOSIS

298.9

UNSPECIFIED PSYCHOSIS

299.00

AUTISTIC DISORDER, CURRENT OR ACTIVE STATE

299.10

CHILDHOOD DISINTEGRATIVE DISORDER, CURRENT OR ACTIVE STATE

299.80

OTHER SPECIFIED PERVASIVE DEVELOPMENTAL DISORDERS, CURRENT OR ACTIVE STATE

299.90

UNSPECIFIED PERVASIVE DEVELOPMENTAL DISORDER, CURRENT OR ACTIVE STATE

301.83

BORDERLINE PERSONALITY DISORDER

303.90

OTHER AND UNSPECIFIED ALCOHOL DEPENDENCE UNSPECIFIED DRINKING BEHAVIOR

304.00

OPIOID TYPE DEPENDENCE UNSPECIFIED USE

304.10

SEDATIVE, HYPNOTIC OR ANXIOLYTIC DEPENDENCE, UNSPECIFIED

304.20

COCAINE DEPENDENCE UNSPECIFIED USE

304.40

AMPHETAMINE AND OTHER PSYCHOSTIMULANT DEPENDENCE UNSPECIFIED USE

304.60

OTHER SPECIFIED DRUG DEPENDENCE UNSPECIFIED USE

304.70

COMBINATIONS OF OPIOID TYPE DRUG WITH ANY OTHER DRUG DEPENDENCE UNSPECIFIED USE

307.1

ANOREXIA NERVOSA

307.51

BULIMIA NERVOSA

307.52

PICA

308.3

OTHER ACUTE REACTIONS TO STRESS

309.0

ADJUSTMENT DISORDER WITH DEPRESSED MOOD

309.21

SEPARATION ANXIETY DISORDER

309.24

ADJUSTMENT DISORDER WITH ANXIETY

309.28

ADJUSTMENT DISORDER WITH MIXED ANXIETY AND DEPRESSED MOOD

309.3

ADJUSTMENT DISORDER WITH DISTURBANCE OF CONDUCT

309.4

ADJUSTMENT DISORDER WITH MIXED DISBURBANCE OF EMOTIONS AND CONDUCT

309.81

POSTTRAUMATIC STRESS DISORDER

311

DEPRESSIVE DISORDER NOT ELSEWHERE CLASSIFIED

780.09

ALTERATION OF CONSCIOUSNESS OTHER

 

 

Diagnoses that Support Medical Necessity 

Those diagnoses reflected in the narrative section of Indications and Limitations of Coverage and/or Medical Necessity above. 

 

ICD-9 Codes that DO NOT Support Medical Necessity 

The following diagnoses (as a primary diagnosis and without a covered psychiatric diagnosis also on the claim) indicate a level of mental disorder for which inpatient treatment is not required. There may be rare exceptions to exclusion from coverage for the following diagnoses. Documentation in the medical record must provide clear rationale for the exception to exclusion.

290.0

SENILE DEMENTIA UNCOMPLICATED

290.10

PRESENILE DEMENTIA UNCOMPLICATED

290.40

VASCULAR DEMENTIA, UNCOMPLIC