S9126, Hospice care, in the home, per diem
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Key Coverage Criteria
- Home hospice services are consideredmedically necessarywhenbothof the following criteria (A and B) below are met:
- The individual requires hospice care, as evidenced by meetingbothof the following criteria (1 and 2):The individual is terminally ill (for example, life expectancy is 6 months or less if illness runs its normal course);andThe individual requires services for the management of a terminal illness and related condition(s).and
- The individual is terminally ill (for example, life expectancy is 6 months or less if illness runs its normal course);and
- The individual requires services for the management of a terminal illness and related condition(s).and
- The individual requireseitherof the following:Routine home hospice services: Services required for less than 8 hours of predominantly nursing care during a 24-hour day, which begins and ends at midnight;orContinuous home care services: Services required whenbothof the following criteria (a and b) are met:The individual requires a minimum of 8 hours of nursing, hospice aide, or homemaker care during a 24-hour day*, which begins and ends at midnight.andThe continuous home care services are provide [...]
- Routine home hospice services: Services required for less than 8 hours of predominantly nursing care during a 24-hour day, which begins and ends at midnight;or
1 Active Policy
ANTHEM-CG-MED-101, CG-MED-101 Home Hospice
Related Codes
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