What this manual covers
Coverage in this manual is the first test a claim must pass. A service that fits a benefit category may still be limited by a national or local coverage determination, and the billing rules for it live in the Claims Processing Manual, so most questions need both manuals.
Use the chapter for the benefit to confirm the coverage conditions and documentation the record must show, then check the NCD or LCD for the specific service and the matching Claims Processing Manual chapter for billing.
Chapter guides
Each guide explains what the chapter governs for billing in plain English, points to the sections billing teams use most, shows how the chapter's rules surface as claim denials and remittance codes, and lists the chapter's current revision and newest transmittals.
All 17 chapters and their current revisions
The revision is the newest one found in the chapter's table of contents and transmittal history. Chapters with a guide link to it; every chapter links to the official PDF on cms.gov, with its page count.
| Ch. | Chapter | Current revision | Official PDF |
|---|---|---|---|
| 1 | Inpatient Hospital Services Covered Under Part A | Rev. 10892, August 6, 2021 | 56 pages |
| 2 | Inpatient Psychiatric Hospital ServicesInpatient psychiatric hospital services under Part A. | Rev. 253, December 14, 2018 | 18 pages |
| 3 | Duration of Covered Inpatient ServicesDuration of covered inpatient services: benefit periods, lifetime reserve days and SNF day limits. | Rev. 261, October 4, 2019 | 7 pages |
| 4 | Inpatient Psychiatric Benefit Days Reduction and Lifetime LimitationThe inpatient psychiatric benefit days reduction and the 190-day lifetime limitation. | Rev. 1, October 1, 2003 | 7 pages |
| 5 | Lifetime Reserve DaysLifetime reserve days and the election not to use them. | Rev. 257, March 1, 2019 | 14 pages |
| 6 | Hospital Services Covered Under Part B | Rev. 12425, December 21, 2023 | 47 pages |
| 7 | Home Health Services | Rev. 12425, December 21, 2023 | 108 pages |
| 8 | Coverage of Extended Care (SNF) Services Under Hospital Insurance | Rev. 12283, October 5, 2023 | 58 pages |
| 9 | Coverage of Hospice Services Under Hospital Insurance | Rev. 13664, March 5, 2026 | 62 pages |
| 10 | Ambulance Services | Rev. 13459, November 26, 2025 | 34 pages |
| 11 | End Stage Renal Disease (ESRD) and Acute Kidney Injury (AKI)End-stage renal disease and acute kidney injury dialysis coverage. | Rev. 13599, January 30, 2026 | 88 pages |
| 12 | Comprehensive Outpatient Rehabilitation Facility (CORF) CoverageComprehensive outpatient rehabilitation facility coverage. | Rev. 255, January 25, 2019 | 18 pages |
| 13 | Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services | Rev. 13600, February 20, 2026 | 72 pages |
| 14 | Medical DevicesMedical devices, including investigational device exemption coverage. | Rev. 198, November 6, 2014 | 9 pages |
| 15 | Covered Medical and Other Health Services | Rev. 13889, July 30, 2026 | 311 pages |
| 16 | General Exclusions From Coverage | Rev. 13593, January 26, 2026 | 39 pages |
| 17 | Opioid Treatment Programs (OTPs)Opioid treatment program coverage. | Rev. 13572, March 3, 2026 | 15 pages |
How to read a manual chapter
Every chapter opens with a table of contents and a revision line showing the newest transmittal that changed it. Sections are numbered in tens with decimal subsections (the Program Integrity Manual prefixes each number with the chapter, as in 3.2.3), and CMS adds new numbers rather than renumbering, which is what makes a citation durable. Directly under each section heading a revision note gives the transmittal number with its issue, effective and implementation dates, so you can tell at a glance whether a rule changed recently and whether the change reached back to earlier dates of service. Instructions are addressed to the Medicare Administrative Contractors, so a sentence such as “MACs shall deny” tells you both the rule and the edit that enforces it.
The transmittal history at the end of the chapter is the change log. Each row gives the revision, the issue date, a subject line, the implementation date and the change request number; the change request itself, published separately on cms.gov, explains the business requirements contractors had to build. When a chapter refers to another publication, such as a coverage condition in the Benefit Policy Manual or a review rule in the Program Integrity Manual, follow the reference: the manuals are written to be read together, and the guides on this site link the matching chapters. Coverage limits for specific services also sit in national and local coverage determinations; the LCD lookup guide shows how to find the contractor policy that applies.
Where QuickIntell fits with Medicare coverage rules
Benefit Policy Manual conditions are checked before the service, not after the denial. QuickAuth coordinates requirement checks, documentation, submission and status tracking with human review, and QuickRCM handles claim readiness and the coverage denials that follow.
Frequently asked questions
How many chapters does the Medicare Benefit Policy Manual have?
The Medicare Benefit Policy Manual (Pub. 100-02) has 17 chapters in the copy CMS posted on cms.gov as of September 27, 2026. Each chapter is a separate PDF with its own table of contents and revision history.
Which Benefit Policy Manual chapter changed most recently?
Chapter 15, Covered Medical and Other Health Services, carries the newest revision in this build: Rev. 13889, issued July 30, 2026. The table on this page lists the current revision of every chapter.
Which Benefit Policy Manual chapters have guides on this site?
9 chapters: 1, 6, 7, 8, 9, 10, 13, 15, 16. A chapter gets a plain-English guide when people search for it by name at least 40 times a month; every other chapter is listed with its official PDF.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.
- Medicare Benefit Policy Manual (Pub. 100-02)Version 17 chapter PDFs; newest revision Rev. 13889 (chapter 15), issued 2026-07-30 · effective 2026-09-27 · file 100-02-benefit-policy-manual/*.pdf (17 chapters; SHA-256 of their sha256sum listing)SHA-256 be35772e4f9f80b4…
Disclaimer
Operational reference to the CMS Medicare Benefit Policy Manual. Chapters change by transmittal; confirm the current chapter PDF on cms.gov before relying on it. Not legal, clinical or billing advice.
Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.