HI 00601.055 Inpatient Hospital Services Counting Toward Maximums

Inpatient hospital services count toward the maximum number of benefit days payable per benefit period only if:

A. Payment for the services was made, or

B. Payment for the service would be made if a request for payment were properly filed and if the physician certified that the services were medically necessary. When payment cannot be made because of the inpatient hospital deductible or coinsurance requirements, the day(s) nevertheless count toward the beneficiary's maximum days of inpatient hospital care.