Implementation of Pre-Payment Editing for Psychiatric Inpatient Hospital Services

Inpatient psychiatric hospitalization provides 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, 24 hour nursing/treatment team evaluation and observation, diagnostic services and psychotherapeutic and medical interventions.

The Local Coverage Determination (LCD): Psychiatric Inpatient Hospitalization (L33624) and its related billing and coding article (A56865) will be implemented with automated edits based on the list of payable diagnoses included in the article. This LCD has not been edited on a prepay basis in the past and this notice serves to alert providers of the upcoming edits. The implementation date for these edits is TBD.

Posted 7/27/2020