FY 2021 Hospice Wage Index Final Rule

The new rule can be found here and a fact sheet can found here. Of note – the modified election statement and addendum requirements were finalized by CMS and will be effective for hospice admissions effective October 1, 2020. The market basket was updated by 2.4% and the FY2021 cap amount is $30,683.93. The 5% cap on wage index decreases due to changes in OMB area delineations was also finalized for FY 2021.


The Indiana Health Coverage Programs (IHCP) posted the following important information to the provider website at in.gov/medicaid/providers on July 28, 2020

Hospice Services (see the module for a complete list of updates)

  • Changed CMCS references to DXC and updated contact information where applicable
  • Updated the Hospice Core and Noncore Services section to provide clarification around nonhospice versus hospice physician services
  • Updated the Hospice Providers Located Outside Indiana section
  • Added a note about the removal of hospital lock-in requirements in the Right Choices Program (Lock-In) Members section
  • Added Emergency Services Only Coverage with Pregnancy Coverage (Package B) to the list in the Programs and Aid Categories Ineligible for the IHCP Hospice Benefit section
  • Updated Table 5 – Indiana Health Coverage Programs Prior Authorization Request Form Fields for Hospice Requests
  • Clarified information and updated the timely filing limit in the Special Batch Claims section
  • Clarified information about hospice per diem rates in the introductory text for Section 6: Billing and Reimbursement and added a note about where to find the current rates
  • Added a note in the Revenue Codes section to clarify usage of revenue codes 651 and 652
  • Updated the Admission to a Nursing Facility for Treatment of Nonterminal Conditions section and Scenario 1 subsection to include cases where the member is admitted directly to a nursing facility for recovery from a nonterminal condition, without first being hospitalized

Code Tables

The following code table updates are accessible from the Code Sets page:

Hospice Services Codes

  • All codes were reviewed

Service Codes That Require Electronic Visit Verification

  • Updated the following table: Procedure Codes and Modifiers for Personal Care Services That Require EVV
  • For details, see BR202029 and BR202030