Hospice Cap Process
This page outlines the process for hospices to file a self-determined aggregate cap.
- Timeline
- Terminated Providers
- PS&R Reports
- Form & Instructions
- Calculation for New Hospices
- Submitting Cap Determinations
- Cap Overpayments
- Confirmation
Timeline
Hospices must file a self-determined aggregate cap 3 – 5 months after the end of each cap year (no earlier than December 31 and no later than February 28).
Terminated Providers
Providers who terminate from the Medicare program in the following cap year (i.e., 2026) must submit both current year (i.e., 2025) and final (terminating) self-determined cap reviews at the same time. After we process the current year self-determined cap submission, we’ll complete all necessary final cap reviews for your agency.
The statutory cap amount for 2026 is $35,361.44.
PS&R Reports
To prepare the cap calculation, obtain your Provider Statistical & Reimbursement (PS&R) Summary and Hospice Cap reports from CMS Identity Management (IDM)
per these instructions.
CGS doesn't send copies of PS&R reports since hospices are responsible for obtaining them directly. However, if you're unable to obtain the reports, you may contact Tom Bisbee (615.660.5560) for assistance.
Form & Instructions
Complete the Provider Self-Determined Aggregate Cap Limitation form
per these instructions.
Calculation for New Hospices
For new hospices that enter the Medicare program and don't participate for an entire cap year, the initial cap calculations must cover a period of at least 12 but less than 24 months.
Example: A hospice enters the program on September 1, 2024. The first cap period is September 1, 2024 – September 30, 2025.
- Order PS&R Summary and Hospice Cap reports from the agency's tie-in date to September 30 of the second cap year (i.e., September 1, 2024 – September 30, 2025).
- To obtain the correct beneficiary count from the Hospice Cap report, add the count from the 2024 and 2025 cap years.
- Calculate a prorated Hospice cap amount by completing each gray-shaded box in the Prorated Cap Amount
form.
Submitting Cap Determinations
Send your completed Provider Self-Determined Aggregate Cap Limitation form
, cover letter, and all supporting documents to one of the following:
| Mailing Address | Email Address | Fax Number |
|---|---|---|
Part A/HHH Audit & Reimbursement |
615.660.5983 Attn: Tom Bisbee |
IMPORTANT NOTE: If CGS doesn't receive the self-determined cap within 7 days of the February 28 due date, we'll issue a Past Due letter and suspend payments.
Cap Overpayments
For any overpayment amount calculated as a result of the self-determined cap, send a check made payable to CGS with a cover letter that explains what the payment is for to:
CGS
P.O. Box 957124
St. Louis, MO 63195-7124
If you don't submit the overpayment at the same time as the self-determined aggregate cap, CGS will demand the overpayment reported on the self-determined aggregate cap.
Confirmation
Upon receipt of a self-determined aggregate cap, CGS will:
- Perform a cursory review for obvious errors.
- Send a confirmation letter within 45 days.
- Perform a final review at a later date.
Updated: 02.04.2026

