100-02 Medicare Benefit Policy Manual: Chapter 1 Crosswalk

Medicare Benefit Policy Manual
Chapter 1 - Inpatient Hospital Services Covered Under Part A
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1 	1 	Definition of Inpatient Hospital
Services
1 	10 	A3-3101 	HO-210 	Covered Inpatient Hospital Services
1 	10.1 	A3-3101.1 	HO-210.1 	Bed and Board
1 	10.1.1 	A3-3101.1A 	HO-210.1A 	Accommodations - General
1 	10.1.2 	A3-3101.1B 	HO-210.1B 	Medical Necessity - Need for Isolation
1 	10.1.3 	A3-3101.1C 	HO-210.1C 	Medical Necessity - Admission
Required and Only Private Rooms
Available
1 	10.1.4 	A3-3101.1D 	HO-210.1D 	Charges for Deluxe Private Room
1 	10.1.5 	A3-3101E 	HO-210.1E 	All Private Room Providers
1 	10.1.6 	A3-3101.1F 	HO-210.1F 	Wards
1 	10.1.6.1 	A3-3101.1F1 	HO-210.1F1 	Assignment Consistent with Program
Purposes

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1 	10.1.6.2 	A3-3101.1F2 	HO-210.1F2 	Assignment Not Consistent with
Program Purposes
1 	10.1.7 	A3-3101.1G 	HO210.1G 	Charges
1 	20 	A3-3101.2 	HO-210.2 	Nursing and Other Services
1 	20.1 	A3-3101.2A 	HO-210-2A 	Anesthetist Services
1 	20.2 	A3-3101.2B 	HO-210.2B 	Medical Social Services to Meet the
Patient's Medically Related Social
Needs
1 	30 	A3-3101.3 	HO-210.3 	Drugs and Biologicals
1 	30.1 	A3-3101.2A 	HO-210.3A 	Drugs Included in the Drug Compendia
1 	30.2 	A3-3101.3B 	HO-210.3.B 	Approval by Pharmacy and Drug
Therapeutics Committee
1 	30.3 	A3-3101.3C 	HO-210-3.C 	Combination Drugs
1 	30.4 	A3-3101.3D 	HO-210.3D 	Drugs Specially Ordered for Inpatients
1 	30.5 	A3-3101.3E 	HO-210.3E 	Drugs for Use Outside the Hospital
1 	40 	A3-3101.4 	HO-210.4 	Supplies, Appliances, and Equipment
1 	50 	A3-3101.5 	HO-210.5 	Other Diagnostic or Therapeutic Items
or Services

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1 	50.1 	A3-3101.5A 	HO-210.5 	Therapeutic Items
1 	50.2 	A3-3101.5B 	HO-210.5 	Diagnostic Services of Psychologists
and Physical Therapists
1 	50.3 	A3-3101.5C 	HO-210.5 	Diagnostic Services Furnished to an
Inpatient by an Independent Clinical
Laboratory under Arrangements with
the Hospital
1 	50.4 	A3-3101.5D 	HO-210.5 	Diagnostic Services Furnished a
Hospital Inpatient Under Arrangement
with the Laboratory of Another
Participating Hospital
1 	60 	A3-3101.6 	HO-210.6 	Services of Interns or Residents-In-
Training
1 	70 	A3-3101.7 	HO-210.7 	Inpatient Services in Connection with
Dental Services
1 	80 	A3-3101.12 	HO-210.13 	Healthcare Associated with Pregnancy
1 	90 	B3-4276.1,.2 	Termination of Pregnancy
1 	100 	A3-3101.13 	Treatment for Infertility
1 	110 	A3-3101.11 	HO-211 	Inpatient Hospital Stays for
Rehabilitation Care
1 	110.1 	A3-3101.11A 	HO-211A 	General

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1 	110.2 	A3-3101.11B 	HO-211B 	42 CFR 412.606 	Preadmission Screening
1 	110.2.1 	Admission Orders
1 	110.3 	A3-3101.11C 	HO-211C 	42 CFR 412.606 	Inpatient Assessment of Individual's
Status and Potential for Rehabilitation
1 	110.3.1 	A3-3101.11C1 	HO-211.C.1 	General
1 	110.3.2 	A3-3101.11C2 	HO-211C2 	Specific Examples
1 	110.4 	A3-3101.11D 	HO-211D 	Rehabilitation Hospital Screening
Criteria
1 	110.4.1 	A3-3101.11D1 	HO-211D.1 	Close Medical Supervision by a
Physician With Specialized Training or
Experience in Rehabilitation
1 	110.4.2 	A3-3101.11D2 	HO-211D.2 	Twenty-Four Hour Rehabilitation
Nursing
1 	110.4.3 	A3-3101.11D3 	HO-211D.3 	Relatively Intense Level of
Rehabilitation Services
1 	110.4.4 	A3-3101.11D4 	HO-211D.4 	Multidisciplinary Team Approach to
Delivery of Program
1 	110.4.5 	A3-3101.11D5 	HO-211D.5 	Coordinated Program of Care
1 	110.4.6 	A3-3101.11D6 	HO-211D.6 	Significant Practical Improvement

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1 	110.4.7 	A3-3101.11D7 	HO-211D.7 	Realistic Goals
1 	110.5 	A3-3101.11E 	HO-211E 	Length of Rehabilitation Program
1 	120 	A3-3101.14 	B3-2300.1 	HO-210.13,
HO-210.12,
Services Related to and Required as a
Result of Services Which Are Not
Covered Under Medicare