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.
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.
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.
- 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.
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.
4 Cited Research Articles
- 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
- Montero Therapy Services. (2014, December 21). Manual? What Manual? Retrieved from https://www.monterotherapyservices.com/compliance/manual-what-manual
- 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
- 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