US · guidance
CMS Pub. 100-04, ch. 30, § 200.2.1
Exceptions
The following situations are not eligible for an expedited determination. Hospitals
should not deliver an IM in these instances.
• When a beneficiary transfers to another hospital at the same level of care (e.g., a
beneficiary transfers from one hospital to another while remaining a hospital
inpatient).
• When beneficiaries exhaust their benefits (e.g., a beneficiary reaches the number
of lifetime reserve days of the Medicare inpatient hospital benefit.)
• When beneficiaries end care on their own initiative (e.g., a beneficiary elects the
hospice benefit).
• Condition Code 44 (CC44) (See Section 50.3 of Chapter 1 of the Medicare
Claims Processing Manual)
• Physician does not concur with discharge. (See Section 220 of this chapter.)
NOTE:
The IM should only be given when an inpatient admission is pending or has occurred. It
should not be given ‘just in case’, such as a hospital delivering to all Medicare patients
being treated in a hospital emergency room.
History
(Rev. 11210; Issued: 01-21-2022; Effective: 04-21-2022; Implementation: 04-21- 2022)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
c9eba1553c1c34cbb56f0169c45d18424adc2e6645a52e46eb537d55758e219c
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