CMS Pub. 100-02, ch. 1, § 10.1.3

Rooms Available

(Rev. 1, 10-01-03)

A3-3101.1.C, HO-210.1.C

A private room is considered to be medically necessary even though the beneficiary's

condition does not require isolation if he/she needs immediate hospitalization (i.e., the

beneficiary's medical condition is such that hospitalization cannot be deferred) and the

hospital has no semiprivate or ward accommodations available at the time of admission.

It need not be considered whether semiprivate or ward accommodations were available in

some other accessible hospital. Where medical necessity exists, the provider may not

charge the beneficiary a private room differential until semiprivate or ward

accommodations become available. Thereafter the provider may transfer the patient to

the nonprivate accommodations, or allow them to continue occupancy of the private

room, subject to an appropriate differential charge (described in §10.1.1 above) if they

request the private room with knowledge of the amount of the charge.

If the admission could be deferred until semiprivate or ward accommodations become

available, the beneficiary should be informed of the amount of the differential he/she

must pay for a private room if he/she wishes to be admitted immediately. The

beneficiary may be charged the specified differential if he/she has been admitted to the

private room at their request (or at the request of their representative) with knowledge of

the amount of the charge.