Definition of Inpatient Hospital Services

1 – Definition of Inpatient Hospital Services (Rev. 1, 10-01-03) Inpatient hospital services are defined in Title XVIII of the Social Security Act (the Act) and in the regulations (42 CFR 409.10): A. Subject to the conditions, limitations, and exceptions set forth in this subpart, the term "inpatient hospital or inpatient CAH services" means the following services furnished to an inpatient of a participating hospital or of a participating CAH or, in the case of emergency services or services in foreign hospitals, to an inpatient of a qualified hospital: 1. Bed and board. 2. Nursing services and other related services. 3. Use of hospital or CAH facilities. 4. Medical social services. 5. Drugs, biologicals, supplies, appliances, and equipment. 6. Certain other diagnostic or therapeutic services. 7. Medical or surgical services provided by certain interns or residents-in- training. 8. Transportation services, including transport by ambulance. B. Inpatient hospital services does not include the following types of services: 1. Posthospital SNF care, as described in 42 CFR 409.20, furnished by a hospital or a critical access hospital that has a swing-bed approval. 2. Nursing facility services, described in 42 CFR 440.155 that may be furnished as a Medicaid service under title XIX of the Act in a swing- bed hospital that has an approval to furnish nursing facility services. 3. Physician services that meet the requirements of 42 CFR 415.102(a) for payment on a fee schedule basis. 4. Physician assistant services, as defined in §1861(s)(2)(K)(i) of the Act. 5. Nurse practitioner and clinical nurse specialist services, as defined in §1861(s)(2)(K)(ii) of the Act. 6. Certified nurse mid-wife services, as defined in §1861(gg) of the Act. 7. Qualified psychologist services, as defined in §1861(ii) of the Act. 8. Services of an anesthetist, as defined in 42 CFR 410.69.