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    v1.0.30
    OpenPayerBilling CodesCare Plan Oversight ServicesCPT cpt-99378-hospice-care-plan-oversight-30-minutes-plus
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    CPT 99378: Hospice Care Plan Oversight, 30+ Minutes

    Commercial payers pay $116 on average nationally for this procedure.

    CPT code 99378 describes a hospice care plan oversight service in which the provider supervises and coordinates care for a hospice patient, spending 30 minutes or more on the patient’s indirect care activities; service type is care plan oversight / hospice supervision and the typical site of service is a hospice or home-based hospice setting.

    For related coverage guidance, see recent payer policy updates: Adult Foster Care, Group Adult Foster Care Clinical Coverage Criteria, Home Health Care Payment Policy.

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    National Reimbursement Benchmarks

    Commercial rates for CPT 99378 vary substantially across major payers, with BUCA (average commercial) centered at $115.80 representing an industry midpoint. UnitedHealth Group and Cigna show the highest central tendencies with medians of $140.40 and $128.00 respectively, while Aetna and Blue Cross Blue Shield present lower medians near $73.00 and $107.20. This distribution positions BUCA close to the overall commercial mean and reflects a market where several large carriers pay notably above and below that average.

    Dispersion measured by the interquartile range (P75–P25) highlights where rates are most consistent or variable: Blue Cross Blue Shield has a range of $44.60, Aetna $51.00, BUCA $27.90, Cigna $79.60, and UnitedHealth Group $83.00. UnitedHealth Group and Cigna are the widest, indicating greater variability in commercial allowed amounts, while BUCA is the tightest, suggesting relatively consistent commercial payments.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A home hospice patient with advanced metastatic cancer is bedbound (Z74.01) and receiving long-term opioid therapy and adjunct medications (Z79.899). The primary hospice medical director (family or internal medicine physician) provides indirect care coordination for the patient’s hospice plan of care, spending 30 minutes or more in activities such as reviewing nursing and hospice aide reports, reconciling medications, discussing symptom management with the interdisciplinary team, telephoning the patient’s primary caregiver about changes in condition, and signing orders for aftercare needs (Z48.89). The workflow begins with nursing or social work identifying an issue (worsening pain, medication level concerns), the hospice physician reviewing clinical records and drug levels (Z51.81), adjusting the plan, documenting time spent in oversight and communications, and updating the hospice care plan. Nonadherence or barriers to the regimen (Z91.19) are addressed through coordination with caregivers and the interdisciplinary team. Billing uses 99378 when the physician’s indirect supervisory and coordination activities total 30 minutes or more during the reporting period.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…
    90Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207Q00000X
    207R00000X
    208D00000X
    133NN1002X
    2279E0002X
    235500000X
    261QC1500X
    2083S0010X

    Related Payer Policy Updates

    Specialty: Home Health & Hospice1 / 2

    10 rows

    PolicyPayerEffective Date
    Adult Foster Carefallon_community_health_plan_inc2027-01-27
    Group Adult Foster Care Clinical Coverage Criteriafallon_community_health_plan_inc2027-01-01
    Home Health Care Payment Policyfallon_community_health_plan_inc2026-12-01
    Private Duty Nursing in the Home SettingAnthem2026-10-01
    Home Health, Skilled, and Custodial Care Services (for Nebraska Only)UnitedHealthcare2026-10-01
    Home Health, Skilled, and Custodial Care Services (for Tennessee Only)UnitedHealthcare2026-10-01
    Home Health, Skilled, and Custodial Care Services (for Kansas Only)UnitedHealthcare2026-09-01
    Private Duty Nursing Services (for Nebraska Only)UnitedHealthcare2026-09-01
    Home Health, Skilled, and Custodial Care Services (for New Jersey Only)UnitedHealthcare2026-09-01
    Home Health, Skilled, and Custodial Care Services (for Idaho Only)UnitedHealthcare2026-08-01

    Related Codes

    CPT-99374-HOME-HEALTH-CARE-PLAN-OVERSIGHT-15-29-MINUTES

    CPT 99374: Home Health Plan-of-Care Supervision, 15–29 Minutes

    CPT-99375-HOME-HEALTH-SUPERVISION-30-MINUTES-INDIRECT-CARE

    CPT 99375: Home Health Agency Care Supervision, ≥30 Minutes

    CPT-99377-HOSPICE-CARE-OVERSIGHT-15-29-MINUTES

    CPT 99377: Hospice Care Plan Oversight (15–29 Minutes)

    CPT-99379-NURSING-FACILITY-CARE-SUPERVISION-15-29-MINUTES

    CPT 99379: Nursing Facility Care Supervision, 15–29 Minutes

    CPT-99380-NURSING-FACILITY-SUPERVISORY-CARE-PLAN-OF-CARE

    CPT 99380: Nursing Facility Care Supervision, Plan of Care

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    99377Under care plan oversight services for hospice, involving 15–29 minutes of indirect careLower-duration sibling code used when indirect supervisory activities total 15–29 minutes instead of 30+ minutes required for 99378.
    99379Under care plan oversight services in a nursing facility, involving 15–29 minutes of indirect careRelated code for oversight performed specifically in a nursing facility with 15–29 minutes of indirect care; contrasts with 99378 by duration and site.