What MAC contractors issue LCDs for Hospice billing?
Hospice billing is subject to regional Local Coverage Determinations (LCDs) from all seven Medicare Administrative Contractors: Noridian, CGS Administrators, First Coast Service Options, National Government Services, Novitas Solutions, Palmetto GBA, and WPS Government Health Administrators. Coverage criteria and medical necessity requirements vary by contractor jurisdiction. CLV Intelligence monitors all MAC contractor sites daily for LCD updates affecting Hospice codes.
How often does CMS update Hospice reimbursement policy?
CMS updates the Physician Fee Schedule annually, effective January 1, with proposed rules published in the summer and final rules in November. MAC contractors issue LCD updates on a rolling basis throughout the year with no fixed schedule. The Federal Register publishes proposed and final rules affecting Hospice reimbursement on a continuous basis. CLV Intelligence monitors all three sources daily and surfaces updates by signal strength.
What is a Local Coverage Determination (LCD) and how does it affect Hospice billing?
A Local Coverage Determination (LCD) is a decision by a Medicare Administrative Contractor specifying under what clinical circumstances a particular service is covered within its geographic jurisdiction. For Hospice billing teams, LCDs define medical necessity criteria, covered diagnoses, and documentation requirements for specific procedures. Failure to comply with LCD requirements is among the most common causes of Medicare claim denial in Hospice practices.