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Hospice Local Coverage Determinations
LCDs provide guidance in determining medical necessity of services.
Cahaba has developed a hospice LCD, Determining Terminal Status, using
the National Hospice and Palliative Care Organization’s (NHPCO) guidelines.
- The LCD allows for the decline of a beneficiary to be a factor in determining prognosis.
- The LCD consists of three parts, and disease specific appendices:
- Part I is related to the decline in a beneficiary predictive of a six month prognosis.
- Part II is related to the functional limitations of a beneficiary, and is used in conjunction with the disease specific appendices. Part II does not stand alone in prediction of a limited prognosis.
- Part III are co-morbidities that may be helpful in predicting and documenting a six-month prognosis.
- Medical review uses the hospice LCD as a guideline to aide in consistency of review.
Page last updated: May 17, 2010
