Hospice - Liver Disease

Summary of Evidence Analysis of Evidence General Information Associated Information Sources of Information Bibliography Revision History Information Associated Documents Attachments Related Local Coverage Documents Related National Coverage Documents Public Versions Keywords Local Coverage Determination (LCD) Hospice - Liver Disease L34544 Expand All | Collapse All  Email Document  Download  Add to basket Contractor Information Contractor Name Contract Type Contract Number Jurisdiction States 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 CPT codes, descriptions, and other data only are copyright 2025 American Medical Association. All Rights Reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. Current Dental Terminology © 2025 American Dental Association. All rights reserved. Copyright © 2025, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and d

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. 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 ( 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.