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 (7 sections)
What is the PPS?
The Palliative Performance Scale rates function in ten-point steps from 100% (normal) to 0% (death) across five columns: ambulation, activity and disease, self-care, intake and consciousness. The LCD guidance uses a PPS below 70% with dependence in at least two activities of daily living as the baseline for most diagnoses. The full table, with every level described, is on the PPS scale page.
What is FAST?
The Functional Assessment Staging tool stages Alzheimer's-type dementia by lost function, from stage 1 (no difficulty) to 7f (cannot hold up the head). The LCD guidance looks for stage 7 or beyond, with all of its findings, plus one complication in the past 12 months. The full table, stages 1 to 7f, is on the FAST scale page.
What are the NYHA classes?
The New York Heart Association classification grades heart failure by the activity that brings on symptoms, from class I (no limitation) to class IV (symptoms at rest). The LCD guidance looks for class IV despite optimal treatment. The four classes are described on the NYHA class page.
What is the KPS?
The Karnofsky Performance Status rates function from 100 (normal) to 0 in ten-point steps. It predates the PPS and the LCD guidance names both, with the same thresholds. The full table, 100 to 0, is on the KPS scale page.
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.
Common questions about the scales
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, and a score alone never decides eligibility: the physician's prognosis, the LCD indicators, the rate of change and the comorbidities do.
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. The dementia criteria page lists the complications.
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. The heart disease criteria page has the supporting findings.
PPS or KPS: which one does the LCD use?
Either. The guidance names both and the thresholds are the same numbers. Chart one scale consistently over time, because the trend over months is what supports a six-month prognosis.
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 person鈥檚 care and coverage, talk with the hospice team.
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