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Hospice Local Coverage Determination (LCD)

LCDs provide guidance in determining medical necessity of services. CGS has developed a hospice LCD, ID# L34538 titled Hospice Determining Terminal Status, using the National Hospice and Palliative Care Organization's (NHPCO) guidelines. Refer to the Medical Policies page to access the hospice LCD.

The LCD:

  • Allows for the decline of a beneficiary to be a factor in determining prognosis.
  • Consists of three parts, and a disease specific appendices:
    • Part I is related to the decline in a beneficiary predictive of a six month prognosis.
    • Part II is related to the functional limitations of a beneficiary, and is used in conjunction with the disease specific appendices. Part II does not stand alone in prediction of a limited prognosis.
    • Part III discusses co-morbidities that may be helpful in predicting and documenting a six-month prognosis.
    • Is used by CGS Medical Review staff as a guideline to aide in consistency of reviews.

Reviewed: 12.08.21


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