For physicians, nurses and discharge planners
Hospice eligibility scales: PPS, FAST, NYHA, KPS
Four scales do most of the work in hospice eligibility. The Palliative Performance Scale (PPS) and the Karnofsky Performance Status (KPS) describe function; the Functional Assessment Staging tool (FAST) describes dementia stage; the New York Heart Association classes describe heart failure. The Medicare hospice LCD guidance names thresholds on each: PPS or KPS below 70% as a baseline for most diagnoses, FAST stage 7 for dementia, NYHA class IV for heart disease. Each level is described here in plain words, with the source for the full instrument.
Medically reviewed by Oscar Chien, MD, Medical Director, October 19, 2026
On this page (9 sections)
What are the PPS levels?
The Palliative Performance Scale rates function in ten-point steps from 100% (normal) to 0% (death), reading five columns left to right: ambulation, activity and evidence of disease, self-care, intake and level of consciousness. The level is the first row where the patient's ambulation fits, adjusted by the later columns. Described here in our words; the instrument itself is published by Victoria Hospice.
| Level | Ambulation | Activity and disease | Self-care | Intake | Consciousness |
|---|---|---|---|---|---|
| 100% | Full | Normal activity and work; no evidence of disease | Full | Normal | Full |
| 90% | Full | Normal activity and work; some evidence of disease | Full | Normal | Full |
| 80% | Full | Normal activity with effort; some evidence of disease | Full | Normal or reduced | Full |
| 70% | Reduced | Unable to do normal work; significant disease | Full | Normal or reduced | Full |
| 60% | Reduced | Unable to do hobby or housework; significant disease | Occasional assistance needed | Normal or reduced | Full or confusion |
| 50% | Mainly sits or lies | Unable to do any work; extensive disease | Considerable assistance needed | Normal or reduced | Full or confusion |
| 40% | Mainly in bed | Unable to do most activity; extensive disease | Mainly assistance | Normal or reduced | Full, drowsy or confused |
| 30% | Totally bed bound | Unable to do any activity; extensive disease | Total care | Normal or reduced | Full, drowsy or confused |
| 20% | Totally bed bound | Unable to do any activity; extensive disease | Total care | Minimal, sips | Full, drowsy or confused |
| 10% | Totally bed bound | Unable to do any activity; extensive disease | Total care | Mouth care only | Drowsy or coma |
| 0% | Death |
Palliative Performance Scale (PPSv2), Victoria Hospice Society. The levels above paraphrase the instrument; use the published scale for scoring.
What PPS score qualifies for hospice?
The LCD guidance uses a PPS or KPS below 70% together with dependence in at least two activities of daily living as the baseline for most diagnoses. Some diagnosis sections set a lower score: the stroke and coma guidance looks for a KPS or PPS of 40% or less, and the dementia guidance relies on FAST rather than PPS. A falling PPS over months is itself a decline indicator. See the eligibility hub and each diagnosis page.
What are the FAST stages?
The Functional Assessment Staging tool stages Alzheimer's-type dementia by lost function, in the order the losses usually occur. Stage 7 is split into substages 7a to 7f. Described here in plain words after Reisberg (1988).
| Stage | What the person can and cannot do |
|---|---|
| 1 | No difficulty, subjectively or objectively |
| 2 | Complains of forgetting where objects are; subjective work difficulty |
| 3 | Decreased job function evident to co-workers; difficulty travelling to new locations |
| 4 | Decreased ability to perform complex tasks, such as planning dinner for guests or handling finances |
| 5 | Needs help choosing proper clothing for the day, season or occasion |
| 6a to 6e | Needs help putting on clothes (6a); bathing (6b); the mechanics of toileting (6c); urinary incontinence (6d); fecal incontinence (6e) |
| 7a | Speech limited to about six intelligible words in an average day |
| 7b | Speech limited to a single intelligible word in an average day |
| 7c | Can no longer walk without personal assistance |
| 7d | Can no longer sit up without assistance |
| 7e | Can no longer smile |
| 7f | Can no longer hold up the head |
Reisberg B. Functional Assessment Staging (FAST). Psychopharmacology Bulletin 1988;24:653-659.
What FAST stage qualifies for hospice?
Stage 7 or beyond, with all of its functional findings (unable to walk, dress or bathe without help, incontinence, speech of six words or fewer), plus at least one complicating condition in the past 12 months. Read the dementia criteria, which lists the complications and the substages.
What are the NYHA classes?
The New York Heart Association functional classification grades heart failure by the activity that brings on symptoms.
| Class | Symptoms |
|---|---|
| I | No limitation of physical activity. Ordinary activity does not cause undue fatigue, palpitation or dyspnea |
| II | Slight limitation. Comfortable at rest; ordinary activity causes fatigue, palpitation or dyspnea |
| III | Marked limitation. Comfortable at rest; less than ordinary activity causes symptoms |
| IV | Unable to carry on any physical activity without discomfort. Symptoms at rest; any activity increases discomfort |
American Heart Association, classes of heart failure.
Which NYHA class qualifies for hospice?
Class IV, with symptoms at rest despite optimal treatment with diuretics and vasodilators, or the documented reasons the patient cannot take them. Read the heart disease criteria for the supporting findings.
What are the Karnofsky scores?
The Karnofsky Performance Status rates function from 100 (normal) to 0 (death) in ten-point steps. It predates the PPS and is still named in the LCD guidance alongside it.
| Score | Description |
|---|---|
| 100 | Normal; no complaints; no evidence of disease |
| 90 | Able to carry on normal activity; minor signs or symptoms of disease |
| 80 | Normal activity with effort; some signs or symptoms of disease |
| 70 | Cares for self; unable to carry on normal activity or to do active work |
| 60 | Requires occasional assistance but is able to care for most needs |
| 50 | Requires considerable assistance and frequent medical care |
| 40 | Disabled; requires special care and assistance |
| 30 | Severely disabled; hospital admission indicated although death not imminent |
| 20 | Very sick; hospital admission necessary; active supportive treatment necessary |
| 10 | Moribund; fatal processes progressing rapidly |
| 0 | Dead |
Karnofsky DA, Burchenal JH, 1949.
PPS or KPS: which one does the LCD use?
Either. The guidance names both, and the thresholds are the same numbers. PPS was built for palliative populations and its columns map onto what hospice nurses assess, so most hospices chart PPS. Chart one scale consistently over time: the trend over months is what supports a prognosis, more than any single score.
Related guides
The eligibility guidelines by diagnosis, benefit periods, recertification and the face-to-face visit and how to refer.
About this page
- Written by
- Beta Hospice care team
- Medically reviewed by
- Oscar Chien, MD, Medical Director
- Last reviewed
- October 19, 2026
- Next review
- April 19, 2027
How we write and review this site
Sources
- CMS Medicare Coverage Database: LCD L33393, Hospice: Determining terminal status (opens in a new tab)
- Victoria Hospice Society: Palliative Performance Scale (PPSv2) (opens in a new tab)
- Reisberg B. Functional Assessment Staging (FAST). Psychopharmacology Bulletin, 1988 (opens in a new tab)
- American Heart Association: Classes and stages of heart failure (NYHA functional classification) (opens in a new tab)
- National Cancer Institute: Karnofsky Performance Status (NCI Dictionary) (opens in a new tab)
These sources support the general information on this page. For one personās care and coverage, talk with the hospice team.
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