Hospice Cardiopulmonary Conditions

Hospice is appropriate for beneficiaries with cardiopulmonary conditions when the primary condition alone or in combination with secondary or comorbid conditions produces impairments and activity limitations consistent with a prognosis of 6 months or less if the illness follows its normal course. Medicare requires sufficient clinical documentation—detailing specific structural/functional impairments, activity limitations, environmental factors, and the impact of secondary/comorbid conditions—to support certification and the hospice plan of care. Conditions primarily amenable to disease-directed long-term management or lacking adequate documentation do not meet hospice coverage.

"Beneficiary with a primary cardiopulmonary condition whose clinical course indicates a prognosis of 6 months or less if the illness runs its normal course."

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