CMS Updates Hospice Coding Requirements

The Centers for Medicare & Medicaid Services (CMS) has updated its Medicare hospice manual, which includes instructions for diagnosis reporting, filling hospice notice of election (NOE) and termination or revocation of election.

The updates go into effect Oct. 1.

The new editing instructions for hospice primary diagnoses and newly required timeframes for submitting information to Home Health & Hospice Medicare Administrative Contractors (MACs)  might impact providers’ reimbursement, a Medicare Learning Network (MLN) memo states.


“The principal diagnosis reported on the claim should be the diagnosis most contributory to the terminal prognosis,” the MLN says. “The coding guidelines state that when the provider has established, or confirmed, a related definitive diagnosis, codes listed under the classification of Symptoms, Signs, and Ill-defined Conditions are not to be used as principal diagnoses.”

Additionally, there are several dementia diagnosis codes that cannot be used as the principal diagnosis.

Hospice NOEs must be filed within five calendar days after the effective date of hospice election, otherwise Medicare will not cover and pay for the days of hospice care from the effective date of election to the date of NOE filing. However, the update does provide for exceptions to this rule, including natural disasters.


The updated manual also provides a clarification of the differences between Healthcare Common Procedure Coding System (HCPCS) site of service codes Q5003 and Q5004.

Read the MLN memo here, or click here to read the official instructions regarding manual changes.

Written by Cassandra Dowell