US · guidance
CMS Pub. 100-04, ch. 3, § 190.11
Benefit Application and Limits-190 Days
The psychiatric benefit lifetime maximum of 190 days of inpatient care applies to
Medicare participating psychiatric hospitals per 42 CFR 409.62. The 190-day lifetime
limitation does not apply to inpatient psychiatric care provided in certified psychiatric
units of an acute care hospital or critical access hospital. Section 409.62 states, “There is a
lifetime maximum of 190 days on inpatient psychiatric hospital services available to any
beneficiary. Therefore, once an individual receives benefits for 190 days of care in a
psychiatric hospital, no further benefits of that type are available to that individual.”
Payment may not be made for more than a total of 190 days of inpatient psychiatric
hospital services during the patient's lifetime. This limitation does not apply to inpatient
psychiatric services furnished in a non-psychiatric hospital. This limitation does not
apply to inpatient psychiatric services furnished in a hospital, a CAH or distinct part
psychiatric unit. The period spent in a psychiatric hospital prior to entitlement does not
count against the patient's lifetime limitation, even though pre-entitlement days may have
been counted against the 150 days of eligibility in the first benefit period.
The Benefit Period provisions described in Medicare Publication 100-01, Medicare
General Information, Eligibility, and Entitlement, chapter 3, §§10.4-10.4.4 are applicable
to inpatients in either a Medicare participating psychiatric hospital or a certified
psychiatric unit of an acute care hospital or critical access hospital.
The CWF keeps track of days paid for inpatient psychiatric services and informs the
Medicare contractor on claims where the 190-day limit is reached.
For a more detailed description see Pub. 100-02, Medicare Benefit Policy Manual, chapter
3, §30.C. and chapter 4, §50 for the 190-day lifetime limitation on payment for inpatient
psychiatric hospital services. For details concerning the pre-entitlement inpatient
psychiatric benefit reduction provision see Pub. 100-02, Medicare Benefit Policy Manual,
chapter 4, §§10 - 50.
History
(Rev. 4104, Issued: 08-03-18, Effective: 10-01-18, Implementation: 10-01-18)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
3587d2d876eabc06f33668e2c6213b2259b6ca598688b854fa27f8e658ca271f
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