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