Local Coverage Determination (LCD)

Hospice - Liver Disease

L34544

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Contractor Information

Contractor Name	Contract Type	Contract Number	Jurisdiction	States
Palmetto GBA	A and B and HHH MAC	11004 - HHH MAC	J - M	Alabama Arkansas Florida Georgia Illinois Indiana Kentucky Louisiana Mississippi New Mexico North Carolina Ohio Oklahoma South Carolina Tennessee Texas

LCD Information

Document Information

LCD ID
L34544

LCD Title
Hospice - Liver Disease

Proposed LCD in Comment Period
N/A

Source Proposed LCD
N/A

Original Effective Date
For services performed on or after 10/01/2015

Revision Effective Date
For services performed on or after 08/01/2024

Revision Ending Date
N/A

Retirement Date
N/A

Notice Period Start Date
N/A

Notice Period End Date
N/A

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Issue

Issue Description

This LCD outlines limited coverage for this service with specific details under Coverage Indications, Limitations and/or Medical Necessity.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1812(a)(4) states in lieu of certain benefits, hospice care with respect to the individual during up to two periods of 90 days each and unlimited number of subsequent periods of 60 days each with respect to which the individual makes an election.

Title XVIII of the Social Security Act, §1814(a)(7)(A)(i) addresses certifying the patient for hospice.

Title XVIII of the Social Security Act, §1861(dd)(1) states the term "hospice care" means the services provided to a hospice patient.

Title XVIII of the Social Security Act, §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act, §1862(a)(6) lists items and services which constitute personal comfort items (except, in the case of hospice care, as it otherwise permitted).

Title XVIII of the Social Security Act, §1862(a)(9) lists items and services where such expenses are for custodial care (except in the case of hospice care, as is otherwise permitted).

42 CFR §418 Hospice Care

CMS Internet-Only Manual, Pub. 100-01, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 4, §60 Certification and Recertification by Physicians for Hospice Care

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 9, §10 Requirements - General, §20.1 Timing and Content of Certification, §20.2 Election, Revocation, and Discharge, §20.2.1 Hospice Election, §40 Benefit Coverage, §40.1 Covered Services, §40.1.1 Nursing Care, §40.1.2 Medical Social Services, §40.1.3 Physicians' Services, §40.1.3.1 Attending Physician Services, §40.1.3.2 Nurse Practitioners as Attending Physicians, §40.1.3.3 Physician Assistants as Attending Physicians, §40.1.4 Counseling Services, §40.1.5 Short-Term Inpatient Care, §40.1.6 Medical Appliances and Supplies, §40.1.7 Hospice Aide and Homemaker Services, §40.1.8 Physical Therapy, Occupational Therapy, and Speech-Language Pathology, §40.1.9 Other Items and Services, §40.2 Special Services, §40.2.1 Continuous Home Care (CHC), §40.2.2 Respite Care, §40.2.3 Bereavement Counseling, §40.2.4 Special Modalities, §40.3 Contracting with Physicians, §40.4 Core Services, §40.4.1 Contracting for Core Services, §40.4.1.1 Contracting for Highly Specialized Nursing Services, §40.4.2 Waiver for Certain Core Staffing Requirements, §40.4.2.1 Waiver for Certain Core Nursing Services, §40.5 Non-core Services and §80 Hospice - Pre-election Evaluation and Counseling Services

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

Medicare coverage of hospice care depends upon a physician’s certification of an individual’s prognosis of a life expectancy of six months or less if the terminal illness runs its normal course. Recognizing that determination of life expectancy during the course of a terminal illness is difficult, this A/B HHH Medicare Administrative Contractor (MAC) has established medical criteria for determining prognosis for non-cancer diagnoses. These criteria form a reasonable approach to the determination of life expectancy based on available research and may be revised as more research is available. Coverage of hospice care for patients not meeting the criteria in this policy may be denied. However, some patients may not meet the criteria, yet still be appropriate for hospice care because of other comorbidities or rapid decline. Coverage for these patients may be approved on an individual consideration basis.

Patients will be considered to be in the terminal stage of liver disease (life expectancy of 6 months or less) if they meet the following criteria (1 and 2 must be present; factors from 3 will lend supporting documentation):

1. The patient should show both a and b:

a. Prothrombin time prolonged more than 5 seconds over control, or International Normalized Ratio (INR)> 1.5

b. Serum albumin <2.5gm/dl

2. End stage liver disease is present, and the patient shows at least one of the following:

a. Ascites, refractory to treatment or patient non-compliance

b. Spontaneous bacterial peritonitis

c. Hepatorenal syndrome (elevated creatinine and blood urea nitrogen (BUN) with oliguria (<400ml/day) urine and sodium concentration <10mEq/l)

d. Hepatic encephalopathy, refractory to treatment, or patient non-compliance

e. Recurrent variceal bleeding, despite intensive therapy

3. Documentation of the following factors will support eligibility for hospice care:

a. Progressive malnutrition

b. Muscle wasting with reduced strength and endurance

c. Continued active alcoholism (>80gm ethanol/day)

d. Hepatocellular carcinoma

e. Hepatitis B virus surface antigen (HBsAg) positivity

f. Hepatitis C refractory to interferon treatment.

Patients awaiting liver transplant who otherwise fit the above criteria may be certified for the Medicare hospice benefit, but if a donor organ is procured, the patient must be discharged from hospice.

Summary of Evidence

N/A

Analysis of Evidence (Rationale for Determination)

N/A

Proposed Process Information

Synopsis of Changes

Changes	Fields Changed
	N/A

Associated Information

Sources of Information

Bibliography

Open Meetings

Contractor Advisory Committee (CAC) Meetings

MAC Meeting Information URLs

Proposed LCD Posting Date

Comment Period Start Date

Comment Period End Date

Reason for Proposed LCD

Requestor Name	Requestor Letter
	View Letter

Requestor Information

Contact for Comments on Proposed LCD

Coding Information

Bill Type Codes

Code	Description
Please accept the License to see the codes.

Revenue Codes

Code	Description
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ICD-10-CM Codes that Support Medical Necessity

ICD-10-CM Codes that DO NOT Support Medical Necessity

Additional ICD-10 Information

General Information

Associated Information

Documentation Requirements

1. Documentation supporting medical necessity should be legible, maintained in the patient’s medical record, and must be made available to the A/B HHH MAC upon request.

2. Documentation certifying terminal status must contain enough information to confirm terminal status upon review. Documentation meeting the criteria outlined in the Coverage Indications, Limitations and/or Medical Necessity section of this Local Coverage Determination (LCD) would meet this requirement.

3. If the patient does not meet the criteria outlined in the Coverage Indications, Limitations and/or Medical Necessity section of this policy, yet is deemed appropriate for hospice care, sufficient documentation of the patient’s condition that justifies terminal status, in the absence of meeting the above criteria, would be necessary.

4. Recertification for hospice care requires that the same standards be met as for the initial certification.

Sources of Information
N/A

Bibliography

Medical guidelines for determining prognosis in selected non-cancer diseases. The National Hospice Organization. Hosp J.1996;11(2):47-63.

Revision History Information

Revision History Date	Revision History Number	Revision History Explanation	Reasons for Change
08/01/2024	R12	Under *CMS National Coverage Policy* updated section headings. Formatting and punctuation were corrected throughout the LCD.	Provider Education/Guidance
10/24/2019	R11	This LCD is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs. There has been no change in coverage with this LCD revision. Regulations regarding billing and coding were removed from the *CMS National Coverage Policy* section of this LCD and placed in the related Billing and Coding: Hospice - Liver Disease A56669 Article. At this time 21^stCentury Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.	Provider Education/Guidance
07/11/2019	R10	All coding located in the *Coding Information* section has been moved into the related Billing and Coding: Hospice - Liver Disease A56669 article and removed from the LCD. Punctuation and typographical errors were corrected throughout the LCD. At this time 21^stCentury Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.	Provider Education/Guidance
05/02/2019	R9	Under *Bibliography* “Consultants and other Medicare Medical Directors” was removed. Formatting and typographical errors were corrected throughout the LCD. Acronyms were inserted where appropriate throughout the LCD.	Provider Education/Guidance
10/01/2018	R8	Under *ICD-10 Codes that Support Medical Necessity: Group 1* added ICD-10 code K83.01. This revision is due to the 2018 Annual ICD-10 Code Update and is effective on October 1, 2018. At this time 21^stCentury Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.	Revisions Due To ICD-10-CM Code Changes
06/07/2018	R7	Under *Coverage Indications, Limitations and/or Medical Necessity* 1.b. added “<2.5 gm/dl” after “Serum albumin”, 2.c. revised the verbiage to read “hepatorenal syndrome (elevated creatinine and blood urea nitrogen (BUN) with oliguria (<400ml/day) and urine sodium concentration <10 mEq/l)” and 3.e. added the verbiage “Hepatitis B virus surface antigen” in front of the acronym “HBsAG” and removed the verbiage “Hepatitis B”. Under *Associated Information – Documentation Requirements* 2. removed the word “policy” and replaced with “Local Coverage Determination (LCD)”, 3.added the word “above” in front of the word “criteria” and 4. added the word “the” in front of the word “initial”. Formatting, punctuation and typographical errors were corrected throughout the policy. At this time 21^stCentury Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.	Provider Education/Guidance Public Education/Guidance
01/01/2017	R6	Under *CPT/HCPCS Codes* the description was revised for HCPCS code G0300. This revision is due to the 2017 Annual CPT/HCPCS Code Update and becomes effective 1/1/17.	Provider Education/Guidance Revisions Due To CPT/HCPCS Code Changes
07/28/2016	R5	Under *CMS National Coverage Policy* in the Title XVIII of the Social Security Act, §1862 (a)(6) and Title XVIII of the Social Security Act, §1862 (a)(9) the verbiage “under paragraph (1)(c)” was deleted and punctuation corrected. The verbiage in the Title XVIII of the Social Security Act, §1812 (a)(4) was revised to read “in lieu of certain benefits, hospice care with respect to the individual during up to two periods of 90 days each and unlimited number of subsequent periods of 60 days each with respect to which the individual makes an election ”. Change Request 9369 was deleted as the information has been manualized and the following reference was added: CMS Internet-Only Manual, Pub 100-04, Medicare Claims Processing Manual, Chapter 11, §§30.2, 30.2.2, and 30.3. Under Associated Information – Documentation Requirements removed the word “the” in front of the verbiage “medical necessity” in the first sentence.	Provider Education/Guidance Typographical Error
01/01/2016	R4	Under CMS National Coverage Policy section added CMS Internet-Only Manual, Pub 100-04 Medicare Claims Processing Manual, Change Request 9369, Transmittal 3378 dated October 16, 2015. Under CPT/HCPCS Codes section added HCPCS codes G0299 and G0300.	Revisions Due To CPT/HCPCS Code Changes
10/01/2015	R3	Under CMS National Coverage Policy added reference to CMS IOM 100-02, Chapter 9 sections 40.1-40.5 all inclusive. Under Coverage Indications, Limitations and/or Medical Necessity made a few punctuation and spacing corrections. Under Sources of Information and Basis for Decision corrected source title.	Provider Education/Guidance Typographical Error Other (Annual Validation)
10/01/2015	R2	Per CMS Internet-Only Manual, Pub 100-08, Medicare Program Integrity Manual, Chapter 13, §13.1.3 LCDs consist of only “reasonable and necessary” information. All bill type and revenue codes have been removed.	Other (Bill type and revenue code removal)
10/01/2015	R1	Under CMS National Coverage Policy added Hospice Care to 42 CFR, Part 418. Under Sources of Information and Basis for Decision updated reference to follow AMA format.	Provider Education/Guidance Other (Maintenance Annual Validation)

Associated Documents

Attachments
N/A

Updated On	Effective Dates	Status
07/23/2024	08/01/2024 - N/A	Currently in Effect	You are here
10/18/2019	10/24/2019 - 07/31/2024	Superseded	View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

Hospice Liver Disease
Liver Disease
Hospice

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Hospice - Liver Disease

Document Note

Note History

Contractor Information

LCD Information

Document Information

Issue

CMS National Coverage Policy

Coverage Guidance

Proposed Process Information

Coding Information

Bill Type Codes

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Revenue Codes

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CPT/HCPCS Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Additional ICD-10 Information

General Information

Revision History Information

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Keywords

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