G9382 HCPCS Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G9382: End-of-Life Plan Not Reviewed or Assistance Not Offered

HCPCS Level II code G9382 indicates that a patient was not offered assistance with end-of-life issues or that an existing end-of-life plan was not reviewed or updated during the measurement period. Nationally, this code highlights gaps in advance care planning documentation and communication that affect care continuity, patient preferences, and quality measurement.

This analysis covers major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical context, the typical service setting where it is captured, and how the absence of documented end-of-life planning is represented in claims data. The publication outlines benchmarks and performance considerations, summarizes relevant policy updates that influence measurement and reporting, and situates G9382 within quality and compliance frameworks.

The content is intended for national audiences involved in billing, compliance, quality improvement, and clinical operations. It explains common use cases for the code, limitations in available input data, and the kinds of metrics and policy drivers that make documentation of advance care planning activities a priority for payers and providers.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9382HCPCS Level IIadvance care planningend-of-life carequality measurementoutpatientambulatory careclaims coding

Billing Code Overview

HCPCS Level II code G9382 denotes that the patient was not offered assistance with end of life issues or an existing end of life plan was not reviewed or updated during the measurement period. This code captures the absence of documented counseling, support, or review related to advance care planning and end-of-life decision-making.

Service type: End-of-life planning assessment or documentation review not completed
Typical site of service: Outpatient clinics, primary care offices, specialty ambulatory settings, and other ambulatory care environments where advance care planning conversations or plan reviews would normally occur

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with advanced chronic illness (for example, metastatic cancer, advanced heart failure, or progressive neurodegenerative disease) who has had one or more outpatient visits during the measurement period but was not offered assistance with end-of-life issues and did not have an existing end-of-life plan reviewed or updated. The clinical workflow begins during a routine primary care or specialty follow-up visit (palliative care, oncology, cardiology, neurology) when the clinician documents prognosis, goals of care, and advance care planning status. For a patient without a documented discussion or without a review/update of an existing plan, the encounter is captured by the billing indicator G9382. Typical site of service is outpatient clinic, ambulatory care center, or home/telehealth visits when advance care planning is expected but not performed. The scenario frequently involves a patient with declining functional status, multiple hospitalizations, or new symptom burden whose chart lacks a current advance directive, POLST/POST, or documented goals-of-care conversation during the measurement period.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when additional work beyond typical visit complexity is documented (rare for this administrative measure).

HCPCS G9822: Endometrial Ablation Within Prior 12 Months

HCPCS-G8856-REFERRAL-OTOLOGIC-EVALUATION

HCPCS G8856: Referral for Otologic Evaluation

HCPCS-G9582-DOOR-TO-PUNCTURE-OVER-90-MINUTES-NO-REASON

HCPCS G9582: Door-to-Puncture Time >90 Minutes, No Reason Given

HCPCS-G0151-HOME-PHYSICAL-THERAPY-15-MINUTE

HCPCS G0151: Physical Therapy in Home Health Setting

HCPCS-G6046-DIHYDROMORPHINONE-MEDICATION-ADMINISTRATION

HCPCS G6046: Dihydromorphinone medication administration

HCPCS-G9522-EMERGENCY-DEPARTMENT-INPATIENT-VISITS-2-PLUS

HCPCS G9522: Multiple ED Visits or Inpatient Hospitalizations, ≥2

HCPCS-G8902-DEMENTIA-MEASURES-GROUP-REPORTING

HCPCS G8902: Dementia Measures Group Reporting

HCPCS-G0455-FECAL-MICROBIOTA-INSTILLATION-PREPARATION

HCPCS G0455: Preparation and Instillation of Fecal Microbiota

HCPCS-G9379-POSTOPERATIVE-RETINAL-FLATNESS-NOT-ACHIEVED-6-MONTHS

HCPCS G9379: Patient Did Not Achieve Flat Retinas Six Months Post Surgery

HCPCS-G9685-EVALUATION-ACUTE-CHANGE-CONDITION-NURSING-FACILITY

HCPCS G9685: Evaluation for Acute Change in Condition in Nursing Facility

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians commonly address advance care planning and documentation.
`207R00000X`	Internal Medicine	General internists manage chronic disease and goals-of-care conversations.
`207V00000X`	Palliative Medicine	Specialists who routinely conduct advance care planning and end-of-life discussions.
`207P00000X`	Oncology	Oncologists frequently review and update end-of-life plans for patients with advanced cancer.
`207L00000X`	Cardiology	Cardiologists manage advanced heart failure patients where goals-of-care discussions are relevant.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99497`	Advance care planning including the explanation and discussion of advance directives, by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate	Performed when advance care planning is actively completed; often used when `G9382` indicates prior absence of such discussion.
`99498`	Advance care planning; each additional 30 minutes	Used when the ACP discussion extends beyond the initial 30 minutes.
`99441`	Telephone evaluation and management service by a physician or other qualified health care professional, 5-10 minutes of medical discussion	May occur as a telephonic follow-up to initiate or document advance care planning when in-person review did not occur.
`99442`	Telephone E/M, 11-20 minutes of medical discussion	Used for longer telephone discussions related to goals of care or advance directives.
`99443`	Telephone E/M, 21-30 minutes of medical discussion	Used for more extended telephonic advance care planning discussions.
`99458`	Each additional 30 minutes of advance care planning on the same date as `99497`	Used when additional time spent on the same date is required to complete documentation or conversation after no prior plan was reviewed.

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