Hospice Calc — Medicare Hospice Payment Calculator

Select a fiscal year and geography to calculate wage-adjusted per diem hospice rates for all four levels of care. Hospice FY runs October 1 – September 30.

Calculator Inputs

Fiscal Year

Hospice submits the required quality data

Wage-Adjusted Rates by Level of Care

Level of Care	Rev Code	Base Rate	Labor / Non-Labor	Wage Index	Adjusted Rate

Enter a 5-digit CBSA code or search by city above to see wage-adjusted rates. Without a selection, rates shown are national unadjusted (wage index = 1.0000).

⚑Rates shown are for hospices that submit required quality data (HQRP). Non-compliant hospices receive a 4-percentage-point reduction to the annual payment update beginning FY 2024 (previously 2-point reduction FY 2020–2023). Geographic adjustment is based on the beneficiary’s location for RHC/CHC and the facility location for GIP/IRC. Rates sourced from CMS Final Rules; verify with your MAC before billing.

National hospice payment rates FY 2020–2026. Year-over-year change shown per level of care. Select a CBSA to add the local wage index column.

Geography

Quality compliant

Rate Trends — FY 2020–2026

⚑Rates are national base rates from CMS Final Rules. YOY Δ calculated per level of care — each LOC moves by a different percentage due to separate wage index standardization factors. Wage index column requires CBSA selection and shows the final rule wage index for each year. Click any row to see the full rate calculation breakdown.

The Medicare hospice aggregate cap limits total annual payments per patient. If a hospice’s total Medicare payments exceed the cap amount × number of Medicare patients served, the overage must be repaid. The cap year runs November 1 – October 31.

Cap Year & Agency Inputs

Cap Year (FY)

Total Medicare Patients Served

Total Medicare Payments Received ($)

Historical Cap Amounts

FY	Cap Amount	Update %	FR Document

⚑The aggregate cap is not adjusted for geographic differences in wages. The cap amount is multiplied by the hospice’s total Medicare patients served in the cap year (Nov 1 – Oct 31). Medicare Administrative Contractors (MACs) determine final cap status. Consult your MAC or a billing specialist before relying on these estimates.

The Service Intensity Add-On (SIA) provides additional payment for RN and Social Worker visits in the last 7 days of life while the patient is receiving Routine Home Care (RHC). SIA equals the CHC hourly rate × hours of care (up to 4 hours/day).

SIA Inputs

Fiscal Year

Submits required quality data

Hours per Day — Last 7 Days of Life (0–4 hrs/day per RN/SW)

CHC Hourly Rates (= SIA Rate) — All Years

FY	CHC Hourly Rate	Max Daily SIA (4 hrs)	Max 7-Day SIA

⚑SIA is paid in addition to the regular RHC per diem. Eligible visits must be provided by an RN or Social Worker; aide visits do not qualify. The SIA rate equals the CHC hourly rate. Verify eligibility criteria with your MAC. Patient must be in the last 7 days of life and receiving RHC at time of service.