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Hospice Coverage Guidelines

Medicare Benefit Policy Manual (CMS Pub. 100-02), Ch. 9External PDF

Medicare pays for hospice care when qualifying criteria are met and documented. It is essential for hospice agencies to have a complete understanding of these criteria, as you have the right, and responsibility, in collaboration with the physician, to decide if the beneficiary qualifies for services. The agency then must understand what services are covered, and how to document these services.

To be eligible to elect the hospice benefit under Medicare, the beneficiary must be entitled to Part A of the Medicare benefit and be certified by a physician as terminally ill. A beneficiary is considered to be terminally ill if the medical prognosis for life expectancy is six months or less if the illness runs its normal course.

Hospice services are provided by various healthcare workers that make up the Interdisciplinary Group (IDG). The services provided by the IDG are directed by the Plan of Care (POC) that is specific for each individual beneficiary.

Refer to the topics below for additional information about hospice eligibility and the services provided under the Medicare hospice benefit.

Hospice Eligibility Hospice Services

Additional Resources

Updated: 06.16.14


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