Nursing Care

40.1.1 - Nursing Care (Rev. 12400; Issued: 12-06-23; Effective: 01-01-24; Implementation: 01-02-24) To be covered as nursing services, the services must require the skills of a registered nurse (RN), or a licensed practical nurse (LPN) or a licensed vocational nurse (LVN) under the supervision of a registered nurse, and must be reasonable and necessary for the palliation and management of the patient’s terminal illness and related conditions. Services provided by a nurse practitioner (NP) who is not the patient’s attending physician, are included under nursing care. This means that, in the absence of an NP, an RN, LPN, or LVN would provide the service. Since the services are nursing, payment is encompassed in the hospice per diem rate and may not be billed separately regardless of whether the services are provided by an NP or an RN. The following are examples of some services that traditionally are provided by an RN, which could also be provided by an NP, for which separate payment is not made: a. A patient with a terminal illness of lung cancer complains of leg pain. In the absence of an NP, an RN would assess the patient. b. Assessment of pain and or symptoms to determine the need for medications, other treatments, continuous home care, general inpatient care etc. In the absence of an NP, an RN would assess the patient. c. Administration of medications through intravenous (e.g., PICC, central, etc.), intrathecal or any other means. In the absence of an NP, an RN would administer the medication. d. Family counseling. In the absence of an NP, an RN, social worker, counselor, marriage and family therapists (MFT) or mental health counselors (MHCs) would provide this service. e. Providing a home visit for assessment or provision of care to a patient who is not his/her patient. In the absence of the NP, the service would be provided by an RN, LPN or LVN. Therefore, the NP cannot bill separately for the service.