HumanaCommercial Clinical Policy

Substance Use Disorder Inpatient Services - Medicare Advantage Form

Chat with GenHealth to automate any policy or prior auth task.


Substance Use Disorder Inpatient Services - Medicare Advantage

Notes: Coverage is subject to change based on the evolving clinical technology and periodic review by Humana and the CMS.

Indications

(129202) Is the inpatient admission for the treatment of illness or injury or to improve the functioning of a malformed body member? 
(129203) Does the admitting physician reasonably expect that the patient requires medically necessary hospital care that crosses two midnights? 
(129204) Is the expectation of the physician for the duration of the medically necessary care based on complex medical factors? 
(129205) Is the necessity for inpatient admission supported by the medical record documentation? 

Contraindications

(129206) Is the inpatient care only for social purposes or reasons of convenience that are not medically necessary? 
YesNoN/A
YesNoN/A

Sign up to see the rest of the questions

Unlock the remaining questions and the full coverage workflow.

Sign up for free
Effective Date

01/01/2024

Last Reviewed

NA

Original Document

  Reference



Coverage Determination

Coverage Limitations
Book a walkthrough

Walk through this policy with us

Review how this policy can be converted into cited criteria, prior authorization checks, and operational automation.