Description:
Hospice care is a multidisciplinary service that provides end-of-life care, including home nursing visits, physicians’ services, available on-call teaching and emotional support for the family, and palliative care of the client. It is a system of family-centered care designed to assist the terminally ill person to be comfortable and to maintain maximum comfort through the final stages of life.

Hospice services are usually provided in the client’s home or in the home of a family member. In general, hospice services are not available to clients who are inpatients in hospital or nursing home facilities.

Policy:
The following criteria must be met in order to receive coverage benefits for hospice care:

• Attending physician must certify client is terminally ill and, with reasonable medical certainty, is not expected to live more than an additional six months.
• All services must receive prior authorization, and the request must provide, at a minimum, the following:
  1. Name of attending/certifying physician
  2. Client’s diagnosis and summary of client’s clinical condition and expected course
  3. Summary of services that are expected to be rendered to the client

Policy Statement:
Hospice care is a multidisciplinary service that provides home nursing visits, physicians’ services, available on-call teaching and emotional support for the family, and physical care of the client. It is a system of family-centered care designed to assist the chronically ill person to be comfortable and to maintain maximum comfort through the final stages of terminal illness.

Coding Section

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross Blue Shield Association technology assessment program (TEC) and other nonaffiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology © American Medical Association. All Rights Reserved" 

History From 2024 Forward     

01012024  NEW POLICY