---
kind: "section"
citation: "42 C.F.R. § 409.61"
title: "42"
number: "409.61"
heading: "General limitations on amount of benefits."
url: "https://uscodex.org/cfr/42/409.61"
---

# §409.61. General limitations on amount of benefits.

- (a) **Inpatient hospital or inpatient CAH services—**
  - (1) **Regular benefit days.** Up to 90 days are available in each benefit period, subject to the limitations on days for psychiatric hospital services set forth in §§ [409.62](/cfr/42/409.62.md) and [409.63](/cfr/42/409.63.md).
    - (i) For the first 60 days (referred to in this subpart as full benefit days), Medicare pays the hospital or CAH for all covered services furnished the beneficiary, except for a deductible which is the beneficiary's responsibility. ([Section 409.82](/cfr/42/409.82.md) specifies the requirements for the inpatient hospital deductible.)
    - (ii) For the next 30 days (referred to in this subpart as coinsurance days), Medicare pays for all covered services except for a daily coinsurance amount, which is the beneficiary's responsibility. ([Section 409.83](/cfr/42/409.83.md) specifies the inpatient hospital coinsurance amounts.)
  - (2) **Lifetime reserve days.** Each beneficiary has a non-renewable lifetime reserve of 60 days of inpatient hospital or inpatient CAH services that he may draw upon whenever he is hospitalized for more than 90 days in a benefit period. Upon exhaustion of the regular benefit days, the reserve days will be used unless the beneficiary elects not to use them, as provided in [§ 409.65](/cfr/42/409.65.md). For lifetime reserve days, Medicare pays for all covered services except for a daily coinsurance amount that is the beneficiary's responsibility. (See [§ 409.83](/cfr/42/409.83.md).)
  - (3) **Order of payment for inpatient hospital or inpatient CAH services.** Medicare pays for inpatient hospital services in the following order.
    - (i) The 60 full benefit days;
    - (ii) The 30 coinsurance days;
    - (iii) **The remaining lifetime reserve days.**
- (b) **Posthospital SNF care furnished by a SNF, or by a hospital or a CAH with a swing-bed approval.** Up to 100 days are available in each benefit period after discharge from a hospital or CAH. For the first 20 days, Medicare pays for all covered services. For the 21st through 100th day, Medicare pays for all covered services except for a daily coinsurance amount that is the beneficiary's responsibility.
- (c) **Renewal of inpatient benefits.** The beneficiary's full entitlement to the 90 inpatient hospital or inpatient CAH regular benefit days, and the 100 SNF benefit days, is renewed each time he or she begins a benefit period. However, once lifetime reserve days are used, they can never be renewed.
- (d) **Home health services.** Medicare Part A pays for all covered home health services 1 with no deductible, and subject to the following limitations on payment for durable medical equipment (DME):
  - (1) For DME furnished by an HHA that is a nominal charge provider, Medicare Part A pays 80 percent of fair compensation.
  - (2) For DME furnished by an HHA that is not a nominal charge provider, Medicare Part A pays the lesser of the following:
    - (i) 80 percent of the reasonable cost of the service.
    - (ii) The reasonable cost of, or the customary charge for, the service, whichever is less, minus 20 percent of the customary (insofar as reasonable) charge for the service.

## Notes

### Amendments

[48 FR 12541, Mar. 25, 1983, as amended at 51 FR 41339, Nov. 14, 1986; 54 FR 4027, Jan. 27, 1989; 58 FR 30666, 30667, May 26, 1993]

### Authority

Authority: 42 U.S.C. 1302 and 1395hh.

### Source

Source: 48 FR 12541, Mar. 25, 1983, unless otherwise noted.

### Amendments

[48 FR 12541, Mar. 25, 1983, as amended at 51 FR 41339, Nov. 14, 1986; 54 FR 4027, Jan. 27, 1989; 58 FR 30666, 30667, May 26, 1993]