Hospice
Medicare-covered comprehensive end-of-life care for beneficiaries with a life expectancy of 6 months or less, paid under the Hospice Payment System.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Payer
- Primary sources
- 1
- Workspace handoff
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Where this comes up
Front-office and billing both hit this term — eligibility before the visit, prior auth before the procedure, contract terms during fee-schedule negotiation, and credentialing whenever a new provider joins or a payer roster lapses. Misses here become denials downstream.
Full definition
What it is in practice
CMS Hospice covers four levels of care (routine, continuous home, inpatient respite, general inpatient) at per diem rates. Election is voluntary and revocable.
How it shows up in your practice
Patients electing hospice waive most Medicare coverage for the terminal illness. Physician services unrelated to the terminal illness still bill Part B.
Sources
- CMS — Hospice Centerhttps://www.cms.gov/medicare/payment/prospective-payment-systems/hospice
Look up hospice rules in Ask D3
Open ask d3 →Related terms
- PayerMedicare Part AThe hospital insurance part of Medicare, covering inpatient hospital, skilled nursing facility, hospice, and limited home health.
- BillingAdvance Care PlanningDiscussion and documentation of patient's goals, values, and preferences for future medical care; billable under CPT 99497 and 99498.
- BillingTransitional Care Management (TCM)Care management following discharge from an inpatient, partial-hospital, or observation stay; CPT 99495 (moderate complexity) and 99496 (high complexity).
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Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryMedicare Part AThe hospital insurance part of Medicare, covering inpatient hospital, skilled nursing facility, hospice, and limited home health.
- GlossaryAdvance Care PlanningDiscussion and documentation of patient's goals, values, and preferences for future medical care; billable under CPT 99497 and 99498.
- GlossaryTransitional Care Management (TCM)Care management following discharge from an inpatient, partial-hospital, or observation stay; CPT 99495 (moderate complexity) and 99496 (high complexity).
- ComplianceOIG LEIE Monthly Exclusion Screening: Process + Audit-Ready LogsMonthly OIG LEIE and SAM.gov exclusion screening for every workforce member and vendor: the workflow, the log fields auditors require, and the escalation path.
- CompliancePECOS Provider Enrollment Verification (2026) — Quarterly ChecklistQuarterly PECOS provider enrollment verification workflow: who to check, the exact lookup steps, the audit log columns, and the revalidation escalation path.
- Glossary270/271 Eligibility Inquiry/ResponseThe HIPAA standard EDI transactions used to verify patient insurance eligibility (270 query, 271 response).
- GlossaryACA Marketplace PlanHealth plans sold through the federal or state-based health insurance marketplaces under the Affordable Care Act.
- GlossaryAdvance Explanation of Benefits (AEOB)Under the No Surprises Act, the advance benefit statement that insurers must provide to insured patients before scheduled services (implementation deferred).
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.