Hospice Alzheimer's Disease & Related Disorders

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 Alzheimer's Disease & Related Disorders L34567 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 L34567 LCD Title Hospice Alzheimer's Disease & Related Disorders 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 02/29/2024 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 copyr

Alzheimer’s Disease (AD) and related disorders may support a prognosis of 6 months or less under many clinical scenarios. The identification of specific structural/functional impairments, together with any relevant activity limitations, should serve as the basis for palliative interventions and care planning. The structural and functional impairments associated with a primary diagnosis of AD are often complicated by comorbid and/or secondary conditions. Comorbid conditions affecting beneficiaries with AD are by definition distinct from the AD itself. Examples include coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD). Secondary conditions, on the other hand, are directly related to a primary condition. In the case of AD, examples include delirium and pressure ulcers. The important roles of comorbid and secondary conditions are described below in order to facilitate their recognition and assist providers in documenting their impact. The Reisberg Functional Assessment Staging (FAST) scale has been used for many years to describe Medicare beneficiaries with AD and a prognosis of 6 months or less. The FAST scale is a 16-item scale designed to parallel the progressive activity limitations associated with AD. Stage 7 identifies the threshold of activity limitation that would support a 6-month prognosis. The FAST scale does not address the impact of comorbid and secondary conditions. These 2 variables are thus considered separately by this policy. FAST Scale Items: Stage #1: No difficulty, either subjectively or objectively Stage #2: Complains of forgetting location of objects; subjective work difficulties Stage #3: Decreased job functioning evident to coworkers; difficulty in traveling to new locations Stage #4: Decreased ability to perform complex tasks (e.g., planning dinner for guests; handling finances) Stage #5: Requires assistance in choosing proper clothing Stage #6: Decreased ability to dress, bathe, and toilet independently: · Sub-stage 6a: Difficulty putting clothing on properly · Sub-stage 6b: Unable to bathe properly; may develop fear of bathing · Sub-stage 6c: Inability to handle mechanics of toileting (i.e., forgets to flush, does not wipe properly) · Sub-stage 6d: Urinary incontinence · Sub-stage 6e: Fecal incontinence Stage #7: Loss of speech, locomotion, and consciousness: · Sub-stage 7a: Ability to speak limited (1 to 5 words a day) · Sub-stage 7b: All intelligible vocabulary lost · Sub-stage 7c: Non-ambulatory · Sub-stage 7d: Unable to sit up independently · Sub-stage 7e: Unable to smile · Sub-stage 7f: Unable to hold head up Comorbid Conditions: The significance of a given comorbid condition is best described by defining the structural/functional impairments, together with any limitation in activity, related to the comorbid condition. For example, a beneficiary with AD and clinically significant CHD or COPD would have specific impairments of cardiorespiratory function (e.g., dyspnea, orthopnea, wheezing, chest pain), which may or may not respond or be amenable to treatment. The identified impairments in cardiorespiratory function would be associated with both specific structural impairments of the coronary arteries or bronchial tree, and may be associated with activity limitations (e.g., mobility, self-care). Ultimately, the combined effects of the AD (FAST stage 7 or beyond) and any comorbid condition should be such that most beneficiaries with AD (FAST stage 7 or beyond) and similar impairments would have a prognosis of 6 months or less. Secondary Conditions: AD may be complicated by secondary conditions. The significance of a given secondary condition is best described by defining the structural/functional impairments, together with any limitation in activity, related to the secondary condition. The occurrence of secondary conditions in beneficiaries with AD is facilitated by the presence of impairments in such body functions as mental functioning and movement functions. Such functional impairments contribute to the increased incidence of secondary conditions, such as delirium and pressure ulcers, observed in Medicare beneficiaries with AD. Secondary conditions themselves may be associated with a new set of structural/functional impairments that may or may not respond or be amenable to treatment. Ultimately, the combined effects of the AD (FAST stage 7 and beyond) and any secondary condition should be such that most beneficiaries with AD and similar impairments would have a prognosis of 6 months or less. The documentation of structural/functional impairments and activity limitations facilitate the selection of intervention strategies (palliative vs. curative) and provide objective criteria for determining the effects of such interventions. The documentation of these variables is thus essential in the determination of reasonable and necessary Medicare hospice services. Summary: For beneficiaries with AD to be eligible for hospice the individual should have a FAST level of greater than or equal to 7 and specific comorbid or secondary conditions meeting the above criteria.