HumanaCommercial Clinical Policy

Psychiatric Partial Hospital Program Services - Medicare Advantage Form

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Psychiatric Partial Hospital Program (PHP) Services

Notes: Coverage determinations are based on individual circumstances and the specifics of the Humana plan as well as adherence to Medicare’s reasonable and necessary requirement. The use of MCG Guidelines may influence medical necessity determinations.

Indications

(546183) Are the PHP services expected to improve or maintain the patient's condition and functional level and to prevent relapse or hospitalization? 
(546184) Is there a need for active treatment of the patient's condition to maintain a functional level and prevent relapse or hospitalization? 
(546185) Is the patient able to participate cognitively and emotionally in the active treatment process and tolerate the intensity of a PHP program? 
(546186) Does the individualized treatment plan describe a coordination of services tailored to the patient's needs and include a multidisciplinary team approach to care under the direction of a physician? 
(546187) Is the patient being discharged from an inpatient hospital treatment program with PHP as a continuation of treatment to shorten an inpatient stay? 

YesNoN/A
YesNoN/A
YesNoN/A

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Effective Date

01/01/2024

Last Reviewed

NA

Original Document

  Reference



Coverage Determination

Coverage Limitations
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