Summary & Overview
HCPCS G9524: Referral to Hospice Care
HCPCS Level II code G9524 documents that a patient was referred to hospice care. This administrative service code captures the clinical decision and care coordination step when a patient transitions to a hospice program. Nationally, accurate use of this code supports continuity of care, appropriate claims processing, and measurement of end-of-life care pathways.
Key payers included in discussions of G9524 are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. These payers commonly process hospice referrals within medical and administrative claim workflows and may use the coded referral to trigger coverage reviews, care coordination activities, or quality reporting.
Readers will learn how G9524 is positioned within clinical and billing workflows, typical sites of service where it is used, and the types of benchmarks and policy considerations that arise around hospice referral documentation. The publication covers coding context, national implications for claims processing and quality measurement, and notes on data availability where specific payer policy details are not provided. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code G9524 indicates patient was referred to hospice care. The service type is referral to hospice, a clinical administrative action documenting that a patient has been referred for hospice services. The typical site of service for this code is inpatient or outpatient clinical settings where referral decisions are made, including hospitals, physician offices, and other ambulatory care locations.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A common scenario involves an adult patient with advanced, progressive illness (for example, metastatic cancer, end-stage heart failure, or advanced chronic obstructive pulmonary disease) who has a life-limiting prognosis and is no longer pursuing curative therapies. During an outpatient or inpatient clinical encounter, the treating physician, palliative care specialist, or hospice liaison evaluates the patient’s disease trajectory, symptom burden, psychosocial needs, and goals of care. After a goals-of-care discussion with the patient and/or surrogate decision-maker, the clinician documents that the patient meets clinical criteria for hospice referral and initiates the hospice referral process. Documentation typically includes the terminal diagnosis, estimated prognosis, functional status, code status discussion, advance care planning, and the name of the hospice organization. The referral may be made from the hospital bedside at discharge planning, during an outpatient palliative care visit, or from a skilled nursing facility. The service captured by G9524 represents the act of referring the patient to hospice care; subsequent care is provided by the hospice organization under hospice benefit rules. Common workflow steps: clinician assessment → goals-of-care discussion and documentation → completion of hospice referral paperwork/authorization → coordination with hospice intake and transfer of clinical information → transition planning for home/SNF/hospice inpatient unit transfer.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |