Hospice FY2027 Payment Rates and Cap Update: Verify Pricer Settings by October 5
CMS Transmittal R13872CP (CR 14557) updates Hospice payment rates, wage index, and cap for FY2027 with a claims system implementation date of October 5, 2026.
Action required by
October 5, 2026
Review the Action Required section below and ensure your team has completed all compliance steps before this date.
CMS Transmittal R13872CP (CR 14557), issued August 7, 2026, under Publication 100-04, updates Hospice payment rates, the Hospice aggregate cap, the Hospice wage index, and the Hospice Pricer for Fiscal Year 2027. This is a claims processing transmittal — not a Proposed Rule — with a system implementation date of October 5, 2026. The single most important compliance implication is that any Hospice claims for services on or after October 1, 2026 must be priced against the FY2027 rate tables; failure to load updated Pricer values before October 5, 2026 will produce incorrect reimbursement on those claims.
Regulatory Background CMS issues annual Hospice payment updates under the statutory authority of the Medicare Hospice Benefit to reflect changes in the market basket index, wage-adjusted geographic differentials, and the aggregate cap amount that limits total Medicare payments to a Hospice per beneficiary per benefit period. CR 14557 operationalizes the FY2027 final payment rule within the shared claims processing systems by updating the Pricer software and supporting rate tables effective with the federal fiscal year start. This is an administrative update implementing a previously finalized rule; the underlying rate-setting rationale is established in the FY2027 Hospice Final Rule rather than in this transmittal.
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Quick answers
The Pricer implementation date is October 5, 2026, but FY2027 starts October 1 — how should claims for October 1–4 services be handled?
CR 14557 sets October 5, 2026 as the system go-live date for the updated Pricer, meaning claims for October 1–4 services may be initially adjudicated at FY2026 rates if processed before October 5. Once the Pricer is live, the MAC will apply FY2027 rates to subsequently processed claims. Monitor remittances for October 1–4 dates of service closely and be prepared to reconcile any rate discrepancies with your MAC if early claims adjudicate at incorrect rates. Consult the full CR 14557 document and your MAC's implementation notice for any retroactive adjustment guidance.
Does CR 14557 change any revenue codes, HCPCS codes, or modifier requirements for Hospice claims?
No. Transmittal R13872CP and CR 14557 are a rate, cap, wage index, and Pricer update under Publication 100-04. The source document does not introduce new revenue codes, HCPCS codes, or modifier requirements. Existing revenue code assignments for the four levels of Hospice care and existing medical necessity documentation standards are not altered by this transmittal.
Where can I find the specific FY2027 per-diem dollar amounts and aggregate cap figure that CR 14557 is implementing?
The transmittal source document (R13872CP) does not itemize specific per-diem dollar amounts or the cap figure. Those values are published in the FY2027 Hospice Final Rule in the Federal Register. Refer to the source document at the URL provided and to the FY2027 Hospice Final Rule for the exact rate and cap figures to load into your fee schedule and cap tracking tool.
Content summarized from publicly available federal publications including CMS, MAC contractors, and the Federal Register. CLV Intelligence is not affiliated with or endorsed by any government agency. This is not legal or medical advice.