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Page 1: Inpatient Rehabilitation Facility (IRF) Admission and ... · Facility Medical Necessity ... Inpatient Rehabilitation Facility (IRF) Admission and Continued Length of Stay Reviews

Medicare Advantage Policy Manual

TOPIC: Inpatient Rehabilitation Facility (IRF) Admission and Continued Length of Stay Reviews Section: Medicare Manual – Utilization Management

Approval Date: March 2014

Policy No: M-UM03 Published Date: 06/01/2014

IMPORTANT REMINDER: The health plan’s Medicare Advantage Medical Policies are developed to provide guidance for members and providers regarding coverage in accordance with the member Evidence of Coverage (EOC) booklet. Benefit determinations are based in all cases on any applicable EOC language and any applicable CMS policy. To the extent there may be any conflict, applicable EOC language or applicable CMS policy take precedence over the health plan’s Medicare Advantage Medical Policy.

MEDICARE MEDICAL POLICY CRITERIA Note: This policy does not apply to skilled nursing facility (SNF) admissions. The Medicare Advantage Medical Policy, M-UM08, addresses SNF admissions and SNF length of stay reviews (see Cross References). Initial Admission Reviews Length of Stay Reviews CMS Coverage Manuals

Medicare Benefit Policy Manual Chapter 1 - Inpatient Hospital

Services Covered Under Part A, See Section 110.2 in the

following link: §110.2 - Inpatient Rehabilitation

Facility Medical Necessity Criteria

Medicare Benefit Policy Manual Chapter 1 - Inpatient Hospital

Services Covered Under Part A, See Section 110.3 in the

following link: §110.3 - Definition of Measurable

Improvement

Note: Please read all applicable sections and subsections, in their entirety, for complete criteria details.

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Regence

Page 2: Inpatient Rehabilitation Facility (IRF) Admission and ... · Facility Medical Necessity ... Inpatient Rehabilitation Facility (IRF) Admission and Continued Length of Stay Reviews

REFERENCES None CROSS REFERENCES Skilled Nursing Facility (SNF) Admissions, Utilization Management, Policy No. M-08

CODES NUMBER DESCRIPTION CPT N/A HCPCS N/A

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