Summary & Overview
HCPCS G9692: Hospice Services Received During Measurement Period
HCPCS Level II code G9692 identifies whether a patient received hospice services at any point during the measurement period. Nationally, capture of hospice utilization is critical for quality measurement, care coordination, and accurate reporting of end-of-life service delivery. This code flags encounters relevant to population health management, value-based contracts, and quality metrics that monitor access to palliative and hospice care.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical context and service setting, an overview of payer coverage patterns where available, and interpretive guidance on how the code is used in measurement and reporting. The publication also summarizes common modifiers and the role of G9692 in quality measurement frameworks.
The content is designed for national audiences—health plan analysts, billing teams, quality officers, and policy stakeholders—who need a clear, practical reference for how G9692 is defined and where it applies. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code G9692 indicates hospice services received by a patient any time during the measurement period. The service type for this code is hospice care, encompassing palliative and supportive services focused on comfort, symptom management, and end-of-life care. The typical site of service is hospice setting or any location where hospice services are delivered, including inpatient hospice facilities, hospice inpatient units, nursing facilities, assisted living, and the patient’s residence.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a terminal illness who receives hospice services during the measurement period. The patient may have advanced metastatic cancer, end-stage heart failure, end-stage chronic obstructive pulmonary disease, advanced dementia, or other progressive, life-limiting conditions. Hospice enrollment occurs when the patient and family elect comfort-focused care and prognostication supports a life expectancy of six months or less if the disease follows its usual course. The clinical workflow begins with a hospice referral from the attending physician or palliative care team, completion of a hospice election and documentation of goals of care in the medical record, verification of eligibility and prognosis, and initiation of hospice services by a licensed hospice interdisciplinary team. Services documented under billing code G9692 include any hospice service provided to the patient at any time during the measurement period, recorded in the hospice or facility chart. Typical sites of service include the patient’s home, a nursing facility, inpatient hospice unit, or hospital when concurrent hospice care is allowed. Common documentation elements include the hospice election form, plan of care, interdisciplinary group notes, symptom management records, and visitation logs reflecting visits by registered nurses, physicians, social workers, chaplains, or aides.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |