February 4, 2025
Reminder: 2024 Hospice Self-Determined Aggregate Cap
NOTE: If CGS doesn’t pay your agency’s Medicare claims, we aren’t responsible for your Hospice Cap work. Please submit your SD Cap and direct any questions to the MAC that pays your claims.
Hospices are required to file a self-determined aggregate cap each year between December 31 and February 28. The 2024 SD Cap is due by February 28, 2025. If we don’t receive your agency’s self-determined cap within 7 days of the final due date, we will issue a Past Due letter and suspend payments.
As a reminder, the Provider Self-Determined Aggregate Cap Limitation form and instructions are available to assist with this process.
Your submission must include:
- Cover letter
- Completed Provider Self-Determined Aggregate Cap Limitation
form
- PS&R Summary and Hospice Cap Reports used to complete the form
- New providers: Prorated Cap Amount
form
Hospices must obtain their own Provider Statistical and Reimbursement (PS&R) Summary Report from the CMS website. CGS offers these instructions and will only provide the report if a hospice encounters an issue and isn’t able to retrieve a copy. Please contact Tom Bisbee at 615.660.5560 for assistance.
See Hospice Cap Process for complete details.