Respite care not medically necessary (Updated for 2026)

Common Causes for HOS17

Denials with code HOS17 typically happen for the following specific reasons:

• Lack of documentation showing that an active, informal caregiver exists and requires temporary relief from intensive caregiving duties.
• The patient permanently resides in a skilled nursing facility (SNF) or assisted living facility where professional staff provide 24/7 care, eliminating the need for caregiver respite.
• The inpatient respite care stay exceeded the statutory Medicare limit of 5 consecutive days, and the excess days were incorrectly billed under the respite revenue code.
• The medical record fails to demonstrate that the patient's care during the respite period required a qualified inpatient setting such as a Medicare-certified hospice unit, SNF, or hospital.

How to Prevent HOS17 Denials

To avoid receiving this denial in the future, implement these specific checks:

• Verify and clearly document the identity, role, and temporary unavailability or burnout of the primary informal home caregiver in the hospice plan of care before initiating respite services.
• Establish system billing edits to automatically transition billing from revenue code 0655 (respite) to routine home care after the 5-consecutive-day statutory limit is reached.
• Confirm that the patient does not permanently reside in an institutional facility where a caregiver is not responsible for day-to-day routine care.
• Audit clinical documentation to ensure nursing notes clearly state the start and end dates of the respite period and confirm the care was delivered in an appropriately certified inpatient facility.

Appeal Letter Template for HOS17

If you believe this claim was denied incorrectly, you can use the following template to submit an appeal.

[Your Practice Header]
[Date]

[Payer Name]
[Appeals Department Address]

RE: Appeal for Claim [Claim Number]
Patient: [Patient Name]
ID: [Patient ID]
Date of Service: [Date]
Denial Code: HOS17 - Respite care not medically necessary

Dear Appeals Department,

I am writing to appeal the denial of the above-referenced claim, which was denied with code HOS17: "Respite care not medically necessary".

According to the CMS Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 9, Section 40.1.5, inpatient respite care is a covered hospice service when necessary to provide short-term relief to the primary, informal caregiver who regularly provides care for the terminally ill individual at home. In this case, the submitted medical records clearly demonstrate that the patient's primary informal caregiver, who coordinates routine daily care at home, required temporary relief due to documented physical exhaustion. The patient was admitted to a Medicare-certified inpatient facility for respite care for a total of four consecutive days, which is fully compliant with the five-day statutory limit defined in 42 CFR Section 418.204(b). Because all clinical, administrative, and documentation requirements for hospice inpatient respite care have been met, we respectfully request that this denial be overturned and the claim be approved for payment.

Attached please find:
1. A copy of the original claim.
2. The relevant medical records supporting the service.
3. [Any other supporting documents].

We respectfully request that you reprocess this claim for payment.

Sincerely,

[Your Name]
[Title]
[Practice Name]