T2046 — Hospice long term care, room and board only; 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
Documentation Required
- Required documentation (as specified in Criteria I) must be submitted.
- Documentation demonstrating terminal diagnosis and expected life expectancy of six months or less.
- Documentation of hospice medical director certification of hospice appropriateness for the initial 90-day certification period
- Written certification must identify the terminal illness diagnosis that prompted the member/enrollee to seek hospice care
Key Coverage Criteria
- Hospice care for members/enrollees with a terminal diagnosis and an expected life expectancy of six months or less, focused on relieving pain and symptoms related to the terminal diagnosis.
- Hospice is considered medically necessary when the requirements in Criteria I (Required Documentation), II (severity of illness), and III are met.
- Cancer as a terminal diagnosis warranting hospice care
- Amyotrophic Lateral Sclerosis (ALS) as a terminal diagnosis warranting hospice care
- Heart disease as a terminal diagnosis warranting hospice care
- Pulmonary disease as a terminal diagnosis warranting hospice care
1 Active Policy
AMBETTER-CP.MP.54 — Hospice Services
Related Codes
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