La. Medicaid Services Manual ch. 24 (Hospice), Appendix C

Diagnosis code(s) are required when submitting a request for hospice services. Certain codes

require criteria that must be met before the associated request can be approved and

appropriate documentation is required on submission. This list is not all inclusive and

additional codes may be added upon request with documentation and justification as to why

the patient has a prognosis of six months or less with this diagnosis. Each code submitted will

be considered on a case-by-case basis.

All claims/authorizations must use the applicable diagnosis codes that reflect the policy

intent.