What is the Medicare Benefit Policy Manual?

The Medicare Benefit Policy Manual, also known as Publication 100-02, is an online-only reference for Medicare health care providers. This official government document details specific rules and regulations that govern the Medicare program.

Rachel Christian, writer and researcher for RetireGuide
  • Written by
    Rachel Christian

    Rachel Christian

    Financial Writer and Certified Educator in Personal Finance

    Rachel Christian is a writer and researcher for RetireGuide. She covers annuities, Medicare, life insurance and other important retirement topics. Rachel is a member of the Association for Financial Counseling & Planning Education.

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    Lee Williams
    Lee Williams, senior editor for RetireGuide.com

    Lee Williams

    Senior Financial Editor

    Lee Williams is a professional writer, editor and content strategist with 10 years of professional experience working for global and nationally recognized brands. He has contributed to Forbes, The Huffington Post, SUCCESS Magazine, AskMen.com, Electric Literature and The Wall Street Journal. His career also includes ghostwriting for Fortune 500 CEOs and published authors.

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    Joe Benish
    Joe Benish, Medicare Expert & RetireGuide Reviewer

    Joe Benish

    Licensed Agent at Insuractive

    As a licensed insurance agent specializing in providing seniors with Medicare-related products, Joe Benish knows how daunting it can be to learn about Medicare and all of the options available. That’s why he spends his time getting to know his clients and helping them select the right plans for them from the more than 15 insurance companies he represents.

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  • Published: June 22, 2021
  • Updated: November 1, 2022
  • 3 min read time
  • This page features 4 Cited Research Articles
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A licensed insurance professional reviewed this page for accuracy and compliance with the CMS Medicare Communications and Marketing Guidelines (MCMGs) and Medicare Advantage (MA/MAPD) and/or Medicare Prescription Drug Plans (PDP) carriers’ guidelines.

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APA Christian, R. (2022, November 1). What is the Medicare Benefit Policy Manual? RetireGuide.com. Retrieved April 12, 2024, from https://www.retireguide.com/medicare/customer-service/medicare-benefit-policy-manual/

MLA Christian, Rachel. "What is the Medicare Benefit Policy Manual?" RetireGuide.com, 1 Nov 2022, https://www.retireguide.com/medicare/customer-service/medicare-benefit-policy-manual/.

Chicago Christian, Rachel. "What is the Medicare Benefit Policy Manual?" RetireGuide.com. Last modified November 1, 2022. https://www.retireguide.com/medicare/customer-service/medicare-benefit-policy-manual/.

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Who Is the Medicare Benefit Policy Manual For?

The Medicare Benefit Policy Manual is one of several internet-only manuals published by the U.S. Centers for Medicare & Medicaid Services, or CMS.

Health care providers, contractors, Medicare Advantage companies and state survey agencies use the Benefit Policy Manual and other publications as a guide to administer Medicare coverage.

The manual includes detailed information regarding day-to-day operating instructions, policies and procedures, all of which are based on government statutes, regulations, guidelines and directives.

While the manual is intended for health care professionals, it can also serve as a rich source of information for members of the general public and Medicare beneficiaries.

What Are the Most Important Chapters?

The Medicare Benefit Policy Manual comprises 17 chapters and covers program guidelines for multiple health care settings.

Hospitals, doctor’s offices, rehabilitation clinics, skilled nursing facilities, home health care companies and others use this information to navigate complex Medicare rules.

The manual largely focuses on the Medicare Part A benefit, with chapters on inpatient hospital coverage, skilled nursing facilities, hospice care, ambulance services, lifetime reserve days, inpatient psychiatric care and home health services.

There’s also guidance on more specific topics, including end-stage renal disease, medical devices and coverage exclusions.

Chapter 17 is the manual’s newest addition. It covers opioid treatment programs.

Medicare Benefit Policy Manual Chapters
  • Chapter 1: Inpatient Hospital Services Covered Under Part A
  • Chapter 2: Inpatient Psychiatric Hospital Services
  • Chapter 3: Duration of Covered Inpatient Services
  • Chapter 4: Inpatient Psychiatric Benefit Days Reduction and Lifetime Limitation
  • Chapter 5: Lifetime Reserve Days
  • Chapter 6: Hospital Services Covered Under Part B
  • Chapter 7: Home Health Services
  • Chapter 8: Coverage of Extended Care (SNF) Services Under Hospital Insurance
  • Chapter 9: Coverage of Hospice Services Under Hospital Insurance
  • Chapter 10: Ambulance Services
  • Chapter 11: End Stage Renal Disease (ESRD)
  • Chapter 12: Comprehensive Outpatient Rehabilitation Facility (CORF) Coverage
  • Chapter 13: Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services
  • Chapter 14: Medical Devices
  • Chapter 15: Covered Medical and Other Health Services
  • Chapter 16: General Exclusions from Coverage
  • Chapter 17: Opioid Treatment Programs (OTPs)

Medicare rules and regulation are specific to each practice setting. Providers should consult the chapter that corresponds to their health care facilities.

For example, Chapter 7 is specific to home health services covered under Medicare Part A. If a home health care agency provides services under Part B, they should refer to chapter 15, which governs all outpatient therapy services.

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Where Can I Find the Medicare Benefits Policy Manual?

The Medicare Benefit Policy Manual is available on the CMS website.

The manual isn’t a single document. Rather, each chapter is a separate, hyperlinked PDF.

Click here for a full list of all the chapters.

For a list of all CMS internet-only manuals, including National Coverage Determinations and the claims processing manual, click here.

New Medicare beneficiaries and their families may find the Medicare & You Handbook more informative and user-friendly than the Medicare Benefit Policy Manual. This comprehensive guide to coverage, benefits and enrollment is updated annually and highlights new policy changes at the beginning of the document.

Last Modified: November 1, 2022

4 Cited Research Articles

  1. Centers for Medicare & Medicaid Services. (2021). Publication 100-02: Medicare Benefit Policy Manual. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS012673
  2. Montero Therapy Services. (2014, December 21). Manual? What Manual? Retrieved from https://www.monterotherapyservices.com/compliance/manual-what-manual
  3. Centers for Medicare & Medicaid Services. (2003). CMS Manual System: Introduction. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/Intro_c00.pdf
  4. Centers for Medicare & Medicaid Services. (n.d.). Internet-Only Manuals (IOMs). Retrieved from https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs