Goodwin Hospice AcademyGet started free

Hospice eligibility · disease-specific

Hospice eligibility: liver disease (end-stage)

End-stage liver disease eligibility centers on lab-based synthetic-function markers plus at least one major decompensation, in a patient who is not a transplant candidate or is declining.

By Goodwin Hospice Academy Editorial Team·Grounded in MAC Liver Disease LCD·Published February 16, 2026

Educational content only. Individual clinicians must confirm current LCD language with their MAC and defer to the hospice medical director for eligibility certification.

Quick criteria

  • PT prolonged > 5 sec above control OR INR > 1.5.
  • Serum albumin < 2.5 g/dL.
  • At least one of: refractory ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatic encephalopathy, recurrent variceal bleeding.
  • Not a transplant candidate OR listed but declining.

Documentation example

A composite narrative illustrating how the LCD framework maps to a real hospice admission (identifying details fictionalized):

Patient is a 68-year-old with decompensated cirrhosis (alcoholic + HCV), INR 2.1, albumin 2.1 g/dL, refractory ascites requiring biweekly paracentesis, recent SBP, grade 3 hepatic encephalopathy episodes, was listed for transplant but delisted for continued alcohol use, current MELD 24.

Workflow for a defensible admission

  1. 01Document synthetic-function labs (INR, albumin, bilirubin).
  2. 02List decompensation events and dates.
  3. 03Note transplant status clearly (never candidate / delisted / declining).
  4. 04Include MELD or MELD-Na if available.
  5. 05Reference the MAC liver LCD in the narrative.

FAQ

Does the patient need to have hepatitis or alcohol history?
No. Etiology does not affect eligibility. Cryptogenic cirrhosis, NASH, autoimmune hepatitis, and inherited liver diseases all follow the same framework.
What if MELD is high but the patient is functional?
A high MELD alone does not establish hospice eligibility. The MAC liver LCD requires both lab findings and at least one decompensation event in a non-transplant candidate.
Can a patient be on hospice while still doing paracentesis?
Yes, when paracentesis is palliative (comfort-focused). Refractory ascites requiring frequent paracentesis is a decompensation event that supports eligibility.

Turn this into a defensible chart.

Use the free Hospice Eligibility Checklist to walk this framework interactively. Copy the paste-ready documentation summary directly into your narrative note.

Open eligibility checklist Benefit Period Calculator

Related conditions

Eligibility

Renal failure (end-stage)

Eligibility

Cancer (advanced / metastatic)

Eligibility

Heart failure (CHF)

Related reading

Article

What is HOPE?

Article

What is IDG?

Sources

  1. CMS Medicare Coverage Database (MAC Liver Disease LCD)
  2. CMS Medicare Benefit Policy Manual, Ch. 9
  3. 42 CFR §418 — Hospice Conditions of Participation

Educational content only. Not a substitute for your organization’s policies, your medical director’s clinical judgment, or current MAC LCDs.