List of Unacceptable Principal Diagnosis Codes Under the Hospice Benefit

Published 03/31/2025

Change Request (CR) 13882 (PDF) provides an updated list of unacceptable principal diagnosis codes under the hospice benefit. Hospices may not report ICD-10-CM codes as the principal diagnosis on hospice claims if the ICD-10-CM code is listed on the unacceptable principal diagnosis list.

The CR also updates Chapter 11, Section 30.3 of the Claims Processing Manual, to provide updated guidance regarding non-reportable principal diagnosis codes; Section 40.2, to provide clarification of liability for claim denials during a hospice election; and Section 50, to include “related conditions” so that the Manual is consistent with Federal Regulations and the Federal Register.

Please see Attachment A of the CR for the list of invalid hospice principal diagnosis codes.

Resource: CR 13882 (PDF).


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