G0031 Palliative Care - HCPCS Reimbursement

HCPCS Level II code G0031 denotes the provision of palliative care services to a patient at any point during the measurement period. This code captures whether a patient received palliative-focused clinical care aimed at symptom management, psychosocial support, and coordination of care, and is used in quality measurement and reporting contexts. Nationally, tracking palliative care delivery is important for assessing access to supportive services, care quality for seriously ill patients, and alignment with value-based care objectives.

Key payers referenced in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what G0031 represents, where the service is typically delivered, and which payers are commonly relevant for coverage and reporting. The publication provides benchmarks and reporting context when available, summarizes relevant policy updates affecting palliative care measurement, and outlines clinical context for how the code is applied in practice.

The content is designed for national audiences interested in billing, compliance, quality measurement, and program administration related to palliative care. Data not available in the input for specific modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service-line details will be noted as unavailable where applicable.

Billing Code Overview

HCPCS Level II code G0031 represents palliative care services given to a patient any time during the measurement period. The service type is palliative care, encompassing multidisciplinary care focused on relief of suffering and symptom management rather than curative treatment. The typical site of service is any clinical setting where palliative care is delivered, including inpatient hospitals, outpatient clinics, hospice programs, and home-based care.

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Clinical Context

A 78-year-old patient with advanced metastatic lung cancer and progressive functional decline is enrolled in palliative care during a 12-month measurement period. The patient receives an interdisciplinary palliative care consult in an outpatient clinic visit and subsequent home visits by a palliative care team to manage complex symptoms (pain, dyspnea, nausea), clarify goals of care, and coordinate hospice referral when appropriate. Documentation includes a problem-focused history, assessment of physical and psychosocial symptoms, medication adjustments, advance care planning discussions, and a plan for ongoing symptom management. Billing uses G0031 to report palliative care services provided at any time during the measurement period, with appropriate encounter notes and team documentation retained in the medical record.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typically required, with supporting documentation.
`23`	Unusual anesthesia	Use when a procedure is performed under general anesthesia for unrelated reasons; rarely applicable but available if anesthesia was required.

Taxonomy Code	Specialty	Notes
`251S00000X`	Palliative Medicine Specialist	Clinicians providing primary palliative care and specialty-level symptom management.
`207Q00000X`	Hospice and Palliative Medicine Physician	Physicians certified in hospice and palliative medicine who lead interdisciplinary care.
`251B00000X`	Pain Medicine Specialist	Manages complex pain issues frequently encountered in palliative patients.
`363A00000X`	Nurse Practitioner	Advanced practice providers delivering palliative care visits and symptom management.
`363L00000X`	Clinical Nurse Specialist	Provides consultative palliative care, education, and care coordination.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C34.90`	Malignant neoplasm of unspecified part of bronchus or lung, unspecified	Common primary cancer diagnosis prompting palliative care for symptom control and care planning.
`C80.1`	Malignant (primary) neoplasm, unspecified	Represents advanced metastatic cancer where palliative services focus on comfort and coordination.
`R53.83`	Other fatigue	Frequent symptom addressed in palliative care medication and activity management.
`R06.02`	Shortness of breath	Dyspnea is a common distressing symptom managed by palliative teams.
`R52`	Pain, unspecified	Pain management is a core focus of palliative care interventions.
`F41.9`	Anxiety disorder, unspecified	Psychological symptom often addressed alongside physical symptoms in palliative care.
`Z51.5`	Encounter for palliative care	Administrative diagnosis code used to indicate palliative care services during the measurement period.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Commonly used for palliative care outpatient follow-up visits addressing symptom management and goals-of-care discussions.
`99406`	Smoking and tobacco use cessation counseling, intermediate, 3-10 minutes	May be provided as part of counseling for patients with serious illness where tobacco cessation is applicable.
`99497`	Advance care planning including the explanation and discussion of advance directives, first 30 minutes	Used when formal advance care planning is performed as part of palliative services; often billed in conjunction with E/M when documented separately.
`99354`	Prolonged service in the office setting, face-to-face, first hour (with direct patient contact, beyond the usual service)	Applied when palliative consultations require extended face-to-face time beyond standard E/M visit lengths for complex communication.
`96127`	Brief emotional/behavioral assessment (eg, depression inventory)	Used for brief standardized assessments of mood or distress common in palliative care evaluations.

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Summary & Overview

HCPCS G0031: Palliative Care Services During Measurement Period