Hospice · Calculator
Hospice Cap Calculator
Estimate the aggregate cap for a cap year — the cap amount times the number of beneficiaries — and compare it to total Medicare payments to see overpayment liability or remaining headroom.
Data statusEstimator
- Status
- Estimator
- Data year / effective
- FY2026
- Last reviewed
- June 2026
- Last updated
- June 2026
- Primary source
- CMS Hospice Wage Index & Rate Update, FY2026
- Known exclusions
- Wage-index adjustment by CBSA not applied
- SIA and cap nuances vary
- Sequestration not applied
Estimate only — wage index, sequestration, and payer/MAC edits are not applied. Validate against CMS and your MAC before billing.
Cap year
Beneficiaries
Use the cap-year beneficiary count from your MAC's cap determination (proportional method). Partial-year and shared beneficiaries count as a fraction.
Payments
Allowable cap
$0.00
Enter beneficiaries and payments
A hospice that exceeds its aggregate cap must repay the difference to Medicare. The cap year runs Oct 1 – Sep 30. This estimate uses the streamlined (proportional) method; your MAC's determination is authoritative.
