Medicare local coverage
Medicare coverage for Psychiatric Inpatient Hospitalization (LCD)
4 Medicare Administrative Contractors publish a local coverage determination (LCD) for Psychiatric Inpatient Hospitalization. The snapshot lists 4 LCD records: 4 active.
An LCD applies only in the jurisdiction of the contractor that wrote it. Two contractors can cover the same service with different criteria, documentation requirements and covered diagnoses, so check the LCD from the contractor that processes your claims.
LCDs by contractor
| Contractor | LCD | Status | Last updated |
|---|---|---|---|
CGS Administrators, LLCMAC - Part A, MAC - Part B | L34183 | Active | Mar 27, 2026 |
First Coast Service Options, Inc.MAC - Part A | L33975 | Active | Jul 2, 2021 |
Palmetto GBAMAC - Part A | L34570 | Active | Apr 9, 2025 |
Wellpoint FederalMAC - Part A, MAC - Part B | L33624 | Active | Jul 14, 2026 |
An LCD marked Future has been finalized and is in its notice period; it applies from the effective date shown. LCD IDs link to the record on cms.gov.
Billing and coding articles
The codes live in the billing and coding article that goes with each LCD: the CPT and HCPCS codes the policy applies to, the ICD-10 codes that support medical necessity, and any modifier or documentation rules.
- A56614Palmetto GBAUpdated Apr 9, 2025
- A56865Wellpoint FederalUpdated Sep 21, 2026
- A57052CGS Administrators, LLCUpdated Apr 3, 2026
- A57726First Coast Service Options, Inc.Updated Oct 13, 2023
Check claim lines against Medicare coverage
Coverage Check tells you whether a claim's diagnoses support Medicare LCD or NCD coverage for each procedure line, and shows the policy and CMS source behind each answer.
Related LCD topics
- Psychiatric Partial Hospitalization Programs
- Home Health - Psychiatric Care
- Partial Hospitalization Programs
- Psychiatric Codes
- Psychiatric Diagnostic Evaluation and Psychotherapy Services
All Medicare LCD topics · National coverage determinations · Payer policies by payer
Source: CMS Medicare Coverage Database, via the public CMS Coverage API, snapshot Oct 25, 2026. LCDs change between snapshots; confirm the version in effect for your date of service on cms.gov before billing.