What is the Medicare Benefit Policy Manual?

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.

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 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.

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.