G9691 Hospice Services (HCPCS) Reimbursement | OpenPayer

Summary & Overview

HCPCS G9691: Patient Received Hospice Services During Measurement Period

HCPCS Level II code G9691 marks that a patient received hospice services at any time during the measurement period. This designation is used in quality measurement, care coordination, and claims reporting to identify populations receiving palliative or end-of-life care. Nationally, capturing hospice status matters for accurate quality measures, risk adjustment, and continuity of care across settings.

Key payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's purpose, common clinical contexts where hospice status is recorded, and how the code is used in administrative and reporting workflows. The publication summarizes benchmarks where available, notes policy or coding updates affecting hospice reporting, and outlines implications for measure inclusion and claims processing.

This coverage is intended for national stakeholders — coders, quality teams, payers, and analysts — seeking a clear reference for G9691 and its role in measurement and reporting. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9691HCPCS Level IIhospicequality-measurementend-of-life-careclaims-reportingpalliative-care

Billing Code Overview

HCPCS Level II code G9691 indicates that a patient had hospice services at any time during the measurement period. This code is an encounter-level/administrative marker used to identify patients who received hospice care during the reporting window.

Service type: Hospice services (palliative, end-of-life care)
Typical site of service: Hospice facility, inpatient hospice unit, patient's home, or other site where hospice care is delivered

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult with a life-limiting illness (for example, metastatic cancer, end-stage heart failure, advanced chronic obstructive pulmonary disease, or progressive neurodegenerative disease) who received hospice services at any time during the measurement period. The clinical workflow begins when the treating physician or advanced practice clinician documents terminal prognosis and hospice eligibility, the patient or surrogate elects hospice, and hospice services (interdisciplinary visits, nursing, social work, bereavement support, durable medical equipment related to comfort, or continuous home care) are initiated. Hospice care may be delivered in the patient’s home, in a nursing facility, in an inpatient hospice unit, or in a hospital when hospice elects to provide services. Documentation includes hospice election forms, certification of terminal prognosis, plan of care, encounter notes from hospice clinicians, and any billing records indicating hospice enrollment during the measurement period. The presence of code G9691 indicates that hospice services were provided at any point during the measurement year and is used for quality measurement and reporting workflows.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Used when work required is substantially greater than typically required (rare for hospice reporting; may apply to significant additional documentation or complex service billing with an associated procedure).

HCPCS G9967: Children Not Screened for Developmental/Behavioral Risk

HCPCS-G2209-PATIENT-REFUSED-TO-PARTICIPATE

HCPCS G2209: Patient Refused to Participate

HCPCS-G9813-POST-PROCEDURE-30-DAY-SURVIVAL

HCPCS G9813: Patient Did Not Die Within 30 Days of Procedure or During Index Hospitalization

HCPCS-G2112-GLUCOCORTICOID-USE-RA-ACTIVITY-WORSENING

HCPCS G2112: Glucocorticoid Use or Worsening RA Activity

HCPCS-G2139-POSTOPERATIVE-BACK-PAIN-VAS-NUMERIC-SCALE

HCPCS G2139: Postoperative Back Pain by VAS/Numeric Scale

HCPCS-G8694-LEFT-VENTRICULAR-EJECTION-FRACTION-LVEF-40-OR-LESS-LVSD-MODERATE-SEVERE

HCPCS G8694: Left Ventricular Ejection Fraction ≤40% or Moderate–Severe LVSD

HCPCS-G9459-TOBACCO-NON-USER-STATUS

HCPCS G9459: Tobacco Non-User Status

HCPCS-G0054-STROKE-CARE-COORDINATION-PREVENTION-OUTCOMES

HCPCS G0054: Coordinating Stroke Care for Prevention and Outcomes

HCPCS-G0059-ANESTHESIA-PATIENT-SAFETY-MIPS-VALUE-PATHWAY

HCPCS G0059: Patient Safety and Positive Anesthesia Experience

HCPCS-G9560-PATIENT-NOT-TREATED-WITH-BETA-LACTAM-DEFINITIVE-THERAPY

HCPCS G9560: Patient Not Treated with Beta-Lactam as Definitive Therapy

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Taxonomy Code	Specialty	Notes
`251S00000X`	Hospice and Palliative Medicine Physician	Primary specialty certifying hospice eligibility and overseeing hospice care.
`2084P0800X`	Registered Nurse (Hospice)	Provides nursing assessments, symptom management, and documentation for hospice enrollment.
`334J00000X`	Social Worker	Provides psychosocial assessment, counseling, and care planning in hospice.
`103T00000X`	Nurse Practitioner	May certify and manage hospice patients and document hospice election.
`309A00000X`	Physician Assistant	May participate in hospice care under supervision and document services.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z51.5`	Encounter for palliative care	Commonly documented when a patient is receiving palliative-focused services or hospice eligibility discussion.
`C80.1`	Malignant (primary) neoplasm, unspecified	Frequently seen among hospice populations with advanced cancer leading to hospice enrollment.
`I50.9`	Heart failure, unspecified	Common diagnosis in patients who may be referred to hospice for end-stage heart failure.
`J96.00`	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	May be present in terminal respiratory illnesses leading to hospice care.
`G30.9`	Alzheimer disease, unspecified	Neurodegenerative disease often resulting in hospice services in advanced stages.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99304`	Initial nursing facility care, per day, for the evaluation and management of a patient, typically 30 minutes	May be used when hospice patients in nursing facilities receive initial E/M visits related to hospice care.
`99307`	Subsequent nursing facility care, per day, typically 15 minutes	Used for ongoing facility-based follow-up visits for hospice patients.
`99223`	Initial hospital care, typically 70 minutes	May be used if hospice care is provided in an inpatient hospital setting and an initial comprehensive E/M is performed.
`99499`	Unlisted evaluation and management service	Occasionally used for nonstandard or hospice-specific bundled services when no specific CPT exists.
`99341`	Home visit for new patient, typically 20 minutes	Used for hospice admission visits performed in the patient’s home by qualified clinicians.
`99347`	Home visit for established patient, typically 20 minutes	Used for follow-up home visits to provide ongoing hospice care and symptom management.

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