HumanaCommercial Clinical Policy

Psychiatric Inpatient Hospitalization - Medicare Advantage Form

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Psychiatric Inpatient Hospitalization

Notes: Coverage is determined in part by federal and local Medicare regulations and may vary based on jurisdiction.

Indications

(658703) Does the physician’s expectation indicate that the patient requires medically necessary hospital care that crosses two midnights? 
(658704) Is the physician’s expectation of the necessity for hospital care based on complex medical factors supported by medical record documentation? 
(658705) Has the patient exhibited a threat to themselves requiring 24-hour professional observation within 72 hours prior to admission? 
(658706) Has the patient exhibited a threat to others requiring 24-hour professional observation within 72 hours prior to admission? 
(658707) Is the patient experiencing command hallucinations directing harm to self or others with the risk of taking action? 

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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