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Guide · Hospice

Hospice Benefit Periods

Hospice coverage is organized into benefit periods, each one re-opened by a fresh certification. There’s no six-month limit — the structure just keeps confirming the patient still qualifies. Here’s how the periods, certifications, and the face-to-face rule fit together. A companion to How Hospice Payment Works.

In short

A patient elects hospice for two 90-day periods, then an unlimited number of 60-day periods. Each new period needs recertification that the patient is still terminally ill, and from the third period on, a face-to-face encounter by a hospice physician or NP within 30 days before it starts.

The benefit periods

The common belief that hospice is “six months” is a misread. Six months is the prognosis threshold, not a coverage limit. Coverage runs in benefit periods that can repeat indefinitely as long as the patient keeps qualifying: two 90-day periods first, then 60-day periods without limit.

Two 90-day periods, then unlimited 60-day periods — coverage never expires if recertified1st90 daysinitial certification2nd90 daysrecertify3rd60 drecert + F2F4th60 drecert + F2F5th +60 d …unlimitedface-to-face encounter required from the 3rd period on
Eligibility is recertified at the start of every period. There is no overall limit — a patient who keeps meeting the terminal-illness criteria can have any number of 60-day periods.

Certification and recertification

Each period opens with a certification of terminal illness — a prognosis of six months or less if the illness runs its normal course. The first period takes two signatures; every period after that takes one.

Initial certificationfirst 90-day periodhospice physician+attending (if any)Both certify a terminal illnesswith a life expectancy of 6 monthsor less if it runs its normal course.Recertificationevery period after the firsthospice physicianThe hospice physician alonerecertifies. Recerts can be done upto 15 days before the next period.
The first period needs the hospice physician and the patient’s attending (if they have one). Every period after that is recertified by the hospice physician alone.

The face-to-face encounter

Starting with the third benefit period, recertification also requires a face-to-face encounter. It exists because reaching a third period means the patient has already outlived the initial six-month window, so CMS asks for in-person confirmation that the prognosis still holds.

≤ 30 days beforeperiod startface-to-face encounterRequired before the 3rd benefit period and every period after.A hospice physician or nurse practitioner sees the patient in person, within the 30 daysbefore the period starts, and documents findings supporting a 6-month-or-less prognosis.
From the third period on, a hospice physician or NP must lay eyes on the patient within 30 days before the period begins. If an NP does it, they pass their findings to the certifying physician.

Electing — and revoking

A patient enters hospice by signing an election statement. It commits them to the hospice benefit for the terminal illness and waives Medicare payment for curative treatment of that illness — but unrelated conditions stay covered, and the election can be revoked at any time.

The election statementChooses the hospice benefit for the terminal illnessWaives Medicare payment for curative treatment of itNames the attending physician the patient choosesOther Medicare coverage continues for unrelated conditions.RevocationThe patient can revokehospice at any time andreturn to standard Medicare.They may also changehospices once per period.
Electing hospice trades curative coverage of the terminal illness for the hospice benefit — but it’s not permanent. A patient can revoke at any time, and unrelated conditions stay covered as usual.

Why it matters

The mechanics are also the compliance risks. A missing or late face-to-face before the third period, an unsigned narrative, or a recert dated after the period starts can each void a claim outright — these are full denials, not partial adjustments. Tracking the period dates is the simplest defense.

Key takeaways

  • Two 90-day periods, then unlimited 60-day periods — no overall cap.
  • The 6-month figure is a prognosis, not a coverage limit.
  • Initial cert: hospice physician + attending; recerts: hospice physician alone.
  • A face-to-face is required from the 3rd period on, within 30 days before it starts.
  • Election waives curative coverage of the terminal illness only — and can be revoked anytime.

Try it on the tools

Benefit Period Tracker →Per-Diem Calculator →Claim Codes →

Last reviewed May 2026. Educational overview only — verify against the current CMS Hospice guidance and 42 CFR 418 before billing.