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Principal Diagnosis Code Reporting Update for Hospice and Manual Updates to Sections 30.3, 40.2, and 50 of Chapter 11 of the Claims Processing Manual: Processing Hospice Claims

The purpose of this Change Request (CR) is to provide an updated list of unacceptable principal diagnosis codes under the hospice benefit. The CR also updates section 30.3 of chapter 11 of the Claims Processing Manual, to provide updated guidance regarding non-reportable principal diagnosis codes, section 40.2, to provide clarification of liability for claim denials during a hospice election, and section 50, to include “related conditions” so that the Manual is consistent with Federal Regulations and the Federal Register.

Download the Guidance Document

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: March 13, 2025

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.