TL;DR
Chapter 9 of the Medicare Benefit Policy Manual sets the coverage rules for the Medicare hospice benefit. It explains who is eligible, the certification of terminal illness with a life expectancy of six months or less, the election, revocation and discharge rules, the benefit periods and face-to-face encounter, the services hospices must cover, coinsurance, and the inpatient and aggregate caps on hospice payment.
Chapter 9 at a glance
- Current revision
- Rev. 13664
- Issued March 5, 2026
- Effective
- October 1, 2025
- Implemented April 6, 2026
- Sections
- 58
- 9 top-level sections
- Transmittals in history
- 15
- Listed at the end of the chapter
- Monthly searches
- 50
- Google Ads, US, October 2026
What chapter 9 governs for billing
Section 10 sets eligibility: the beneficiary must be entitled to Part A and certified as terminally ill, meaning a medical prognosis of a life expectancy of six months or less if the illness runs its normal course. Coverage runs in benefit periods, two 90-day periods followed by an unlimited number of 60-day periods. Section 20 covers certification and election. The hospice medical director or physician member of the interdisciplinary group and the attending physician, if any, certify the first period, the hospice recertifies each later period, and a hospice physician or nurse practitioner must have a face-to-face encounter with the patient no more than 30 calendar days before the third benefit period and each one after it (20.1).
The election statement and its addendum, the notice of election, revocation by the beneficiary, and discharge by the hospice are explained in 20.2. By electing hospice the beneficiary waives Medicare payment for care related to the terminal illness by anyone other than the hospice or the attending physician, which is why other providers' claims are edited during an election. Section 20.3 and 20.4 cover nursing facility residents, dual eligibles and Medicare Advantage enrollees.
Section 40 lists the covered services, which the hospice must provide directly or arrange: nursing, medical social services, physician services including the attending physician, counseling, short-term inpatient care for pain control or symptom management and for respite, medical appliances and supplies including drugs, hospice aide and homemaker services and therapies, plus continuous home care during periods of crisis and bereavement counseling (40.1 and 40.2). Section 30 sets the small coinsurance for drugs and respite care, and section 90 explains the limit on inpatient days and the aggregate cap on total hospice payments.
Sections billing teams use most
Section numbers and headings are CMS's; the notes are ours. Each section number opens the official chapter 9 PDF at the page where that section starts.
| Section | CMS heading | Why it matters |
|---|---|---|
| 10 | Requirements - General | Eligibility, terminal illness and the 90-, 90- and 60-day benefit periods. |
| 20.1 | Timing and Content of Certification | Timing and content of certification, including the face-to-face encounter. |
| 20.2.1 | Hospice Election | The hospice election statement and its addendum. |
| 20.2.2 | Hospice Revocation | Revocation of the hospice election by the beneficiary. |
| 40.1.3 | Physicians' Services | Physicians' services under hospice, including the attending physician. |
| 40.2.1 | Continuous Home Care (CHC) | Continuous home care during periods of crisis. |
| 90.2 | Aggregate Cap on Overall Reimbursement to Medicare-certified Hospices | The aggregate cap on overall hospice reimbursement. |
How chapter 9 shows up on claims and denials
Hospice coverage denials usually come from review of the certification and the record. When the documentation does not support a life expectancy of six months or less, or a required face-to-face encounter is missing or late, the days are denied as not reasonable and necessary or as failing program requirements, reason code 50 or 272. Section 50 explains how the limitation on liability applies to some of these denials.
Other providers see chapter 9 through the election waiver. Care related to the terminal illness furnished outside the hospice is denied for a patient with an open election, reason code B9, unless it is billed by the attending physician or for an unrelated condition with the modifiers and condition codes in the Claims Processing Manual chapter 11.
Codes you are likely to see on the remittance when a claim runs into this chapter's rules. The code pages explain each code's meaning, root causes and the usual fix.
| Code | Type | When it appears |
|---|---|---|
| B9 | Claim adjustment reason code | Patient enrolled in hospice; related care belongs to the hospice. |
| 50 | Claim adjustment reason code | Hospice care not reasonable and necessary for the period billed. |
| 272 | Claim adjustment reason code | Coverage requirements not met, such as a missing face-to-face encounter. |
Current revision and recent transmittals
The chapter PDF posted on cms.gov is current through Rev. 13664, issued March 5, 2026, effective October 1, 2025, implemented April 6, 2026 (change request 14384). That revision changed sections 20.1 (Timing and Content of Certification), 20.2.1 (Hospice Election), 20.2.2 (Hospice Revocation), 20.2.3 (Hospice Discharge).
Sections ordered by the date in the revision note printed under each heading.
| Section | Heading | Revision |
|---|---|---|
| 20.1 | Timing and Content of Certification | Rev. 13664, March 5, 2026; effective October 1, 2025 |
| 20.2.1 | Hospice Election | Rev. 13664, March 5, 2026; effective October 1, 2025 |
| 20.2.2 | Hospice Revocation | Rev. 13664, March 5, 2026; effective October 1, 2025 |
| 20.2.3 | Hospice Discharge | Rev. 13664, March 5, 2026; effective October 1, 2025 |
| 60 | Provision of Hospice Services to Medicare/Veteran's Eligible Beneficiaries | Rev. 12696, June 25, 2024; effective March 25, 2024 |
| 40.1.1 | Nursing Care | Rev. 12400, December 6, 2023; effective January 1, 2024 |
| 40.2.1 | Continuous Home Care (CHC) | Rev. 12400, December 6, 2023; effective January 1, 2024 |
| 20.2.1.2 | Hospice Election Statement Addendum | Rev. 11056, October 21, 2021; effective October 1, 2021 |
Section index
Every section in the chapter's table of contents, grouped under its top-level heading, with the PDF page where it starts. Open a heading to see its subsections.
10 Requirements - General · p. 4
20 Certification and Election Requirements · p. 5 · 11 subsections
- Open section 20 in the PDF
- 20.1 Timing and Content of Certification · p. 5
- 20.2 Election, Revocation, and Discharge · p. 9
- 20.2.1 Hospice Election · p. 9
- 20.2.1.1 Hospice Election Statement · p. 11
- 20.2.1.2 Hospice Election Statement Addendum · p. 13
- 20.2.1.3 Hospice Notice of Election · p. 16
- 20.2.2 Hospice Revocation · p. 18
- 20.2.3 Hospice Discharge · p. 18
- 20.2.4 Hospice Notice of Termination or Revocation · p. 21
- 20.3 Election by Skilled Nursing Facility (SNF) and Nursing Facilities (NFs) Residents and Dually Eligible Beneficiaries · p. 21
- 20.4 Election by Managed Care Enrollees · p. 22
30 Coinsurance · p. 22 · 2 subsections
- Open section 30 in the PDF
- 30.1 Drugs and Biologicals Coinsurance · p. 22
- 30.2 Respite Care Coinsurance · p. 23
40 Benefit Coverage · p. 23 · 25 subsections
- Open section 40 in the PDF
- 40.1 Covered Services · p. 25
- 40.1.1 Nursing Care · p. 25
- 40.1.2 Medical Social Services · p. 26
- 40.1.3 Physicians' Services · p. 26
- 40.1.3.1 Attending Physician Services · p. 27
- 40.1.3.2 Nurse Practitioners as Attending Physicians · p. 28
- 40.1.3.3 Physician Assistants as Attending Physicians · p. 29
- 40.1.4 Counseling Services · p. 30
- 40.1.5 Short-Term Inpatient Care · p. 30
- 40.1.6 Medical Appliances and Supplies · p. 32
- 40.1.7 Hospice Aide and Homemaker Services · p. 32
- 40.1.8 Physical Therapy, Occupational Therapy, and Speech-Language Pathology · p. 32
- 40.1.9 Other Items and Services · p. 33
- 40.2 Special Services · p. 33
- 40.2.1 Continuous Home Care (CHC) · p. 33
- 40.2.2 Respite Care · p. 37
- 40.2.3 Bereavement Counseling · p. 37
- 40.2.4 Special Modalities · p. 38
- 40.3 Contracting With Physicians · p. 38
- 40.4 Core Services · p. 38
- 40.4.1 Contracting for Core Services · p. 39
- 40.4.1.1 Contracting for Highly Specialized Nursing Services · p. 39
- 40.4.2 Waiver for Certain Core Staffing Requirements · p. 40
- 40.4.2.1 Waiver for Certain Core Nursing Services · p. 40
- 40.5 Non-Core Services · p. 41
50 Limitation on Liability for Certain Hospice Coverage Denials · p. 42
60 Provision of Hospice Services to Medicare/Veteran's Eligible Beneficiaries · p. 43
70 Hospice Contracts with An Entity for Services not Considered Hospice Services · p. 43 · 1 subsections
- Open section 70 in the PDF
- 70.1 Instructions for the Contractual Arrangement · p. 45
80 Hospice Pre-Election Evaluation and Counseling Services · p. 45 · 2 subsections
- Open section 80 in the PDF
- 80.1 Documentation · p. 47
- 80.2 Payment · p. 48
90 Caps and Limitations on Hospice Payments · p. 48 · 8 subsections
- Open section 90 in the PDF
- 90.1 Limitation on Payments for Inpatient Care · p. 49
- 90.2 Aggregate Cap on Overall Reimbursement to Medicare-certified Hospices · p. 51
- 90.2.1 New Hospices · p. 51
- 90.2.2 Counting Beneficiaries for Calculation · p. 52
- 90.2.3 Changing Aggregate Cap Calculation Methods · p. 56
- 90.2.4 Other Issues · p. 57
- 90.2.5 Updates to the Cap Amount · p. 57
- 90.3 Administrative Appeals · p. 58
Using this chapter in a denial or appeal
Start with the remittance. The claim adjustment reason code says what happened to the line, the remark code narrows it, and the group code says who is liable. Match that to the section of the chapter that sets the rule, then read the section in the official PDF rather than a summary: the wording that matters, such as a time limit, a modifier requirement or a documentation element, is usually a single sentence. Check the revision note under the section heading, because a rule that changed after the date of service may not apply to the claim, and an effective date earlier than the issue date can make a new rule reach back.
When the chapter supports the claim, cite it precisely in the redetermination request: the publication number, chapter, section and revision. When it does not, the fix is usually a corrected claim or better documentation rather than an appeal, and a coding or format rejection is corrected and resubmitted because it carries no appeal rights. Manual instructions bind the Medicare Administrative Contractor, so they settle most first-level disputes; at the hearing level, administrative law judges give them substantial deference without being bound by them. If the issue turns on whether a service is covered at all, read the matching Benefit Policy Manual chapter and any national coverage determination or local coverage determination as well, because coverage and billing rules are written in different places.
How QuickIntell works with Benefit Policy Manual chapter 9
QuickAuth coordinates requirement checks, documentation, submission and status tracking with human review, so the coverage conditions in this chapter are looked at before the service. QuickRCM handles claim readiness and the coverage denials that follow.
Frequently asked questions: chapter 9
Who is eligible for the Medicare hospice benefit?
Under chapter 9 section 10, a beneficiary entitled to Part A who is certified as terminally ill, meaning a medical prognosis of a life expectancy of six months or less if the illness runs its normal course.
When is a hospice face-to-face encounter required?
Section 20.1 requires a hospice physician or nurse practitioner to see the patient no more than 30 calendar days before the third benefit period recertification and before each later recertification.
How long are hospice benefit periods?
Two 90-day periods followed by an unlimited number of 60-day periods, each requiring recertification of terminal illness.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.
- Medicare Benefit Policy Manual, Chapter 9: Coverage of Hospice Services Under Hospital InsuranceVersion Rev. 13664, issued 2026-03-05 · effective 2025-10-01 · file bp102c09.pdfSHA-256 29df9d8b4a51ef52…
- Medicare Benefit Policy Manual (Pub. 100-02)Version 17 chapter PDFs; newest revision Rev. 13889 (chapter 15), issued 2026-07-30 · effective 2026-09-27 · file 100-02-benefit-policy-manual/*.pdf (17 chapters; SHA-256 of their sha256sum listing)SHA-256 be35772e4f9f80b4…
Disclaimer
This guide summarizes a CMS manual chapter in our own words for billing teams; section headings and transmittal subjects are quoted from the chapter PDF. The chapter itself is the authority, and it changes by transmittal. Not legal, clinical or billing advice.
Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.