Questions billers ask › How does Medicare reimburse hospice routine home care?

How does Medicare reimburse hospice routine home care?

Answered from the public Medicare sources on 2026-09-15. The quoted text is the source; the note beneath it is what our AI found. You decide what applies to your claim.

The rule, word for word

“(a) CMS establishes payment amounts for specific categories of covered hospice care. (b) Payment amounts are determined within each of the following categories: (1) Routine home care day. A routine home care day is a day on which an individual who has elected to receive hospice care is at home and is not receiving continuous care as defined in paragraph (b)(2) of this section. (i) Service intensity add-on. Routine home care days that occur during the last 7 days of a hospice election ending with a patient discharged due to death are eligible for a service intensity add-on payment. (ii) The service intensity add-on payment shall be equal to the continuous home care hourly payment rate, as described in paragraph (e)(4) of this section, multiplied by the amount of direct patient care actually provided by a RN and/or social worker, up to 4 hours total per day. (2) Continuous home care day. A continuous home care day is a day on which an individual who has elected to receive hospice care is not in an inpatient facility and receives hospice care consisting predominantly of nursing care on a continuous basis at home. Home health aide (also known as a hospice aide) or homemaker services or both may also be provided on a continuous basis. Continuous home care is only furnished during brief periods of crisis as described in § 418.204(a) and only as necessary to maintain the terminally [...]”

42 CFR § 418.302, Subpart G -- Payment for Hospice Care -- § 418.302 Payment procedures for hospice care.
Published2026-04-06 Captured2026-04-06
sha256:a3fc62e7…5002bcbc · Source

What our AI found in the sources

Hospice reimbursement from home refers to the routine home care (RHC) payment category under the Medicare hospice benefit. A routine home care day is a day on which an individual who has elected hospice care is at home and is not receiving continuous care; the hospice is paid a fixed daily rate for each day the beneficiary is under hospice care at home, regardless of the amount of services furnished on any given day. Routine home care can be provided wherever the patient calls "home," including nursing homes and assisted living facilities, and represents approximately 98 percent of all hospice care provided.

Also cited

Federal Register, document 2018-08773, § 418.3 (Hospice Length of Stay)
Published2018-05-08 Captured2018-05-08
sha256:85860bb8…dcbc40cd · Source

42 CFR § 418.302, Subpart G -- Payment for Hospice Care -- § 418.302 Payment procedures for hospice care.
Published2026-04-06 Captured2026-04-06
sha256:a3fc62e7…5002bcbc · Source

If this comes up on one of your claims

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