Summary & Overview
HCPCS G0337: Hospice Evaluation and Counseling, Pre-Election
HCPCS Level II code G0337 denotes hospice evaluation and counseling services provided before a patient formally elects the Medicare hospice benefit. The code is used for professional encounters focused on assessing hospice eligibility and counseling patients and families about hospice options, goals of care, and care planning. Nationally, pre-election hospice counseling is a critical touchpoint for serious-illness decision-making and care coordination, impacting utilization of hospice services and advance care planning.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for pre-election hospice evaluation, the typical sites where these services occur, and the policy and billing considerations relevant to this code. The publication outlines benchmarking metrics and reimbursement context where available, summarizes common billing modifiers and practical coding notes, and highlights policy updates affecting hospice counseling prior to hospice election.
This summary is intended for healthcare administrators, billing professionals, and policy analysts seeking a concise reference on HCPCS Level II code G0337, including its clinical purpose and payer relevance at the national level.
Billing Code Overview
HCPCS Level II code G0337 represents hospice evaluation and counseling services, pre-election. This code covers professional services provided to patients and families to evaluate hospice eligibility and to counsel regarding hospice care prior to a formal election of the Medicare hospice benefit.
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Service type: Hospice evaluation and counseling
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Typical site of service: Hospice program outpatient setting, hospital, long-term care facility, or patient residence where pre-election counseling and eligibility evaluation are performed.
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Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult with a serious, progressive, or life-limiting illness and their family seeking information about hospice care options before electing hospice. For example, a 78-year-old patient with advanced congestive heart failure and repeated hospitalizations is referred by the primary care physician for a hospice pre-election evaluation. A hospice clinician (registered nurse, physician, or social worker) conducts a comprehensive counseling session in the patient’s home or outpatient clinic to review prognosis, hospice eligibility criteria, expected services, and the election process. The workflow includes scheduling the visit, obtaining informed consent, performing eligibility assessment (functional status, prognosis, diagnosis review), documenting goals of care discussions and advance directive status, educating the patient and family about inpatient versus routine home hospice benefits and medication coverage, and completing required hospice pre-election documentation to support a future hospice election. Communication with the referring physician and primary insurer is documented as appropriate, and any immediate symptom needs are triaged for follow-up by the hospice interdisciplinary team.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Anesthesia by surgeon (CMS: professional component) | Not typically used for G0337; included only if reporting a distinct professional component under payer rules (rare). |