Medicare AdvantageCoverageMedium impact
Psychiatric Inpatient Hospitalization - Medicare Advantage (Revised)
Humana·Psychiatry·Medicare Advantage
Effective date
Sep 2, 2025
We identified it
Jun 24, 2026
Summary
Humana has updated their Medicare Advantage policy for psychiatric inpatient hospitalization coverage, emphasizing the two-midnight benchmark rule and medical necessity criteria. The policy clarifies that inpatient admissions must be medically necessary and cross two midnights, with coverage determinations based on specific CMS guidelines and Local Coverage Determinations.
Action Required
Before September 2, 2025: Review psychiatric inpatient hospitalization documentation to ensure compliance with two-midnight benchmark rule and medical necessity criteria. Update billing procedures to reference appropriate Local Coverage Determinations (L33624, L34183, L34570, L33975) based on geographic jurisdiction. Ensure psychiatric inpatient admissions include proper documentation of complex medical factors and medical necessity justification to avoid claim denials.