Hospice Care for a Beneficiary’s Terminal Illness

20.2.2 - Hospice Care for a Beneficiary’s Terminal Illness (Rev.4163, Issued: 11-02-18, Effective: 12-04-18, Implementation: 12-04-18) Hospice care related to a beneficiary’s terminal condition is excluded from SNF PPS and consolidated billing. This is because section 1862(a)(18) of the Social Security Act (the Act) specifies that SNF consolidated billing applies to “…covered skilled nursing facility services described in section 1888(e)(2)(A)(i)…” Section 1888(e)(2)(A)(i) of the Act, in turn, defines “covered skilled nursing facility services” specifically in terms of (I) Part A SNF services, along with (II) those non-excluded services that (if not for the enactment of SNF consolidated billing) would be types of services “…for which payment may be made under Part B…” (emphasis added). Hospice services would not fall within the scope of clause (I) above because, unlike the diagnostic and therapeutic services covered under the Part A SNF benefit (see §1862(a)(1)(A) of the Act), hospice services are palliative (see §1862(a)(1)(C) of the Act). Hospice services also would not fall within the scope of clause (II) above, because this clause encompasses services that, if not for the enactment of consolidated billing, would be separately coverable under Part B, whereas the hospice benefit is a Part A benefit. Hospice services for terminal conditions are identified with the following types of bill: 81X or 82X. Services unrelated to the beneficiary’s terminal condition are designated by the presence of condition code 07. Such unrelated services are included in SNF PPS and consolidated billing.