Medicare Benefit Policy Manual 
Chapter 1 - Inpatient Hospital Services Covered Under Part A 
Crosswalk 
New  New  Int.   Carrier  HO  Other  Title 
Chap  Section  Pub 13  Pub. 14 
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  New  New  Int.   Carrier  HO  Other  Title 
Chap  Section  Pub 13  Pub. 14 
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  New  New  Int.   Carrier  HO  Other  Title 
Chap  Section  Pub 13  Pub. 14 
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  New  New  Int.   Carrier  HO  Other  Title 
Chap  Section  Pub 13  Pub. 14 
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  New  New  Int.   Carrier  HO  Other  Title 
Chap  Section  Pub 13  Pub. 14 
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,    Services Related to and Required as a 
HO-210.12,  Result of Services Which Are Not 
Covered Under Medicare