HI 00601.115 Inpatient Service Days Counting Toward Maximums

Inpatient hospital (including psychiatric and tuberculosis hospitals) services count toward the maximum number of benefit days payable per benefit period only if:

1. A. 

   payment for the services is made, or

2. B. 

   payment for the services would be made if a request for payment were properly filed.

However, where payment cannot be made because of the inpatient deductible or coinsurance requirement, the inpatient day(s) used in satisfying these requirements nevertheless counts toward the beneficiary's maximum inpatient days.

Similarly, inpatient psychiatric hospital services count toward the 190-day lifetime limitation on inpatient psychiatric hospital services only if these conditions are met.