HCPCS G9693: Patient Use of Hospice Services During Measurement Period - OpenPayer

Summary & Overview

HCPCS G9693: Patient Use of Hospice Services During Measurement Period

HCPCS Level II code G9693 designates patient use of hospice services at any time during a specified measurement period. The code serves as a standardized marker for hospice utilization in quality measurement, reporting, and population health management. Nationally, capturing hospice use is important for tracking end-of-life care patterns, aligning care with patient preferences, and supporting quality frameworks that monitor transitions and palliative care access.

Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical meaning and service context, plus what to expect from payer coverage patterns and reporting implications. The publication summarizes common modifiers and operational considerations, presents benchmarks where available, and outlines policy and clinical contexts that influence hospice reporting and measurement. The content is intended to inform coding, compliance, and quality measurement stakeholders about the role of G9693 in documenting hospice use and integrating that information into care management and performance measurement efforts. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9693HCPCS Level IIhospicepalliative carequality measurementend-of-life carereportingservice utilization

Billing Code Overview

HCPCS Level II code G9693 indicates patient use of hospice services any time during the measurement period. This code is used to document and report that an eligible patient received hospice care at any point within the defined measurement window.

Service type: Hospice services
Typical site of service: Hospice facility, patient's home, or other site where hospice care is delivered

Clinical & Coding Specifications

Clinical Context

A 78-year-old patient with advanced metastatic lung cancer is transitioned to hospice care during the measurement period after goals-of-care discussions document a focus on comfort-only measures. The patient has been receiving curative-intent and disease-directed treatments but, following a multidisciplinary review and documented patient/family preference, the attending physician completes hospice enrollment. Hospice services include routine home visits by hospice nurses, coordination of palliative medications, psychosocial support, and intermittent inpatient respite as needed. For quality measurement and reporting, the presence of any hospice service use during the measurement period is captured and billed with G9693 to indicate the patient received hospice services at any point in that period. Typical workflow steps include: initial hospice referral and consent, physician certification of terminal prognosis, hospice admission and plan-of-care documentation, ongoing hospice clinical notes and encounters, and administrative coding/billing to reflect G9693 for applicable payors.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Rarely applies; use if substantially greater work is documented for hospice-related procedures when billable services beyond typical hospice scope are provided by another billable provider.

HCPCS G8755: Most Recent Diastolic Blood Pressure ≥ 90 mmHg

HCPCS-G2134-FRAILTY-WITH-DEMENTIA-MEDICATION-DISPENSED

HCPCS G2134: Frailty with Dispensed Dementia Medication

HCPCS-G0061-ANESTHESIOLOGY-MIPS-SPECIALTY-SET

HCPCS G0061: Anesthesiology MIPS Specialty Set

HCPCS-G9981-REMOTE-IN-HOME-NEW-PATIENT-EVALUATION-MANAGEMENT

HCPCS G9981: Remote In-Home New Patient Evaluation and Management

HCPCS-G9651-PSORIASIS-ASSESSMENT-DOCUMENTATION-NOT-MEETING-BENCHMARKS

HCPCS G9651: Psoriasis Assessment Tool Not Documented or Not Meeting Benchmarks

HCPCS-G0553-DIGITAL-MENTAL-HEALTH-TREATMENT-MANAGEMENT-20-MIN

HCPCS G0553: Digital Mental Health Treatment Management, First 20 Minutes

HCPCS-G8916-PREOPERATIVE-IV-ANTIBIOTIC-SSI-PROPHYLAXIS-INITIATED-ON-TIME

HCPCS G8916: Preoperative IV Antibiotic SSI Prophylaxis Initiated on Time

HCPCS-LEVEL-II-G9734-PATIENT-REFUSED-PARTICIPATION

HCPCS Level II G9734: Patient Refused to Participate

HCPCS-G9834-METASTATIC-DISEASE-AT-DIAGNOSIS

HCPCS G9834: Metastatic Disease at Diagnosis

HCPCS-G9601-POSTOPERATIVE-DISCHARGE-TO-HOME-DAY-7

HCPCS G9601: Patient Discharge to Home by Postoperative Day 7

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`251B00000X`	Hospice and Palliative Medicine	Primary specialty coordinating hospice certification, admission, and plan of care.
`207H00000X`	Family Medicine	Common attending physicians who certify hospice eligibility and provide end-of-life care planning.
`207L00000X`	Internal Medicine	Hospitalists and internists who document terminal prognosis and refer to hospice.
`2080S00000X`	Geriatric Medicine	Frequently manages complex older adults and hospice transitions.
`251S00000X`	Palliative Care Medicine	Specialists providing symptom management and hospice coordination.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z51.5`	Encounter for palliative care	Directly indicates receipt of palliative-focused care and commonly coincides with hospice enrollment during the measurement period.
`C34.90`	Malignant neoplasm of unspecified bronchus or lung, unspecified site	Advanced lung cancer is a common terminal diagnosis prompting hospice services.
`C80.1`	Malignant (primary) neoplasm, unspecified	Used when cancer is advanced and site-specific coding is not available; often present in hospice populations.
`I50.9`	Heart failure, unspecified	Advanced heart failure with refractory symptoms is a frequent reason for hospice referral.
`J44.9`	Chronic obstructive pulmonary disease, unspecified	End-stage COPD with progressive respiratory failure commonly results in hospice care.
`G30.9`	Alzheimer disease, unspecified	Advanced dementia with decline in function frequently leads to hospice enrollment.
`N18.6`	End stage renal disease	Patients with ESRD who forgo dialysis or have refractory symptoms may utilize hospice services.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99306`	Subsequent nursing facility care, per day, for the evaluation and management of a patient, typically 35 minutes	May be billed by clinicians providing ongoing evaluation and management for patients who later enroll in hospice during the measurement period.
`99307`	Nursing facility services, per day, typically 25 minutes	Used for shorter daily E/M encounters in long-term care settings preceding or concurrent with hospice admission.
`99223`	Initial hospital care, typically 70 minutes	Hospital-based initial evaluation that documents terminal prognosis and may precipitate hospice enrollment billed with `G9693` for hospice use reporting.
`99497`	Advance care planning including the explanation and discussion of advance directives, first 30 minutes	Frequently performed prior to or during hospice transition to document goals of care and surrogate designation.
`99499`	Unlisted evaluation and management service	Occasionally used for hospice-related non-standard services when no specific CPT exists; not for reporting hospice use but for associated billable activities.

OpenPayer