MedicaidAdministrativeMedium impact
Administratively Necessary Days for psychiatric inpatient stays
Harvard Pilgrim Health Care·MA · Psychiatry·Provider Newsletter
We identified it
Jun 20, 2026
Summary
Tufts Health Plans has clarified strict criteria for Administratively Necessary Days (AND) for psychiatric inpatient stays, requiring clinical case reviews and specific discharge readiness criteria. Providers must use revenue code 169 for AND reimbursement and can only use AND status when patients are ready for discharge to a lower level of care but appropriate beds are unavailable.
Action Required
Immediately: Billing team must ensure revenue code 169 is used for Administratively Necessary Days reimbursement for Tufts Health Together, Tufts Health One Care, and Tufts Health Plan SCO members. Clinical staff must conduct required case reviews before moving psychiatric inpatients to AND status, documenting that patients are ready for lower level of care discharge, clinical barriers are addressed, and patients don't require high daily clinical resources. Update psychiatric billing workflows to reflect these requirements.