G9694 Hospice Services — HCPCS Reimbursement & Policy

Headline: HCPCS Level II code G9694 Flags Hospice Use During Measurement Period

Lead: HCPCS Level II code G9694 denotes any hospice services received by a patient during the measurement period, a key marker used in quality measurement and care coordination across payers. The code captures whether hospice care occurred at any point in the reporting window, informing assessments of end-of-life care patterns and service utilization nationally.

Why it matters: Recording hospice utilization with G9694 matters for national reporting, care continuity, and population-level measurement of palliative and end-of-life services. Accurate capture affects quality metrics and can inform payer program design and policy discussions about hospice access and timing.

Key payers covered: Analysis and reporting commonly include major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

What readers will learn: This publication explains the clinical meaning of G9694, outlines typical sites of service for hospice care, and summarizes the code’s role in quality measurement and reporting. Readers will find an overview of payer coverage focus, common reporting contexts, and what is available versus missing from the input data (for example, associated taxonomies, ICD-10 diagnoses, and related codes are not provided).

Billing Code Overview

HCPCS Level II code G9694 indicates hospice services utilized by the patient at any time during the measurement period. This code represents the occurrence of hospice care use for quality measurement and reporting purposes.

Service type: Hospice care services
Typical site of service: Hospice settings or other locations where hospice services are delivered, including inpatient hospice facilities, home hospice, or community-based hospice programs.

Clinical Context

A typical patient scenario involves a hospice-enrolled adult with a terminal illness (for example, advanced metastatic cancer, end-stage heart failure, or advanced dementia) who receives hospice services at any point during a defined measurement period. The patient may be receiving hospice care at home, in a hospice inpatient unit, in a long-term care or skilled nursing facility, or in a hospital where hospice services are arranged. Clinical workflow includes hospice admission by a qualified hospice provider, documentation of prognosis and goals of care, interdisciplinary care planning (medical, nursing, social work, spiritual care), periodic visits and symptom management, and documentation of hospice utilization in the patient’s medical record and claims. Billing for hospice utilization during the measurement period is captured using G9694 to indicate that hospice services were utilized by the patient at any time during the measurement period.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When work required is substantially greater than typical; rarely used with hospice encounter claims but applicable if a specific service accompanying hospice care meets criteria
`52`

Taxonomy Code	Specialty	Notes
`251S00000X`	Hospice and Palliative Medicine	Primary specialty responsible for hospice medical direction and clinical oversight
`207P00000X`	Internal Medicine	Common attending physicians managing complex chronic conditions in hospice patients
`207RH0000X`	Family Medicine	Frequently provides primary care and hospice decision-making for home hospice patients
`174400000X`	Nursing	Hospice nurses provide ongoing symptom management and visits
`251B00000X`	Social Worker	Behavioral health and psychosocial support within the hospice interdisciplinary team

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C80.1`	Malignant neoplasm, unspecified, with metastasis	Common terminal oncologic diagnosis leading to hospice enrollment
`I50.84`	End stage heart failure	Advanced cardiac failure is a frequent indication for hospice services when prognosis is limited
`F03.90`	Unspecified dementia without behavioral disturbance	Advanced dementia often leads to hospice care for comfort-focused needs
`J96.01`	Acute respiratory failure with hypoxia	Respiratory decline in advanced disease can prompt hospice transition for symptom-focused care
`N18.6`	End stage renal disease	Patients with ESRD may elect hospice when disease is terminal and dialysis is discontinued
`G30.9`	Alzheimer disease, unspecified	Progressive neurodegenerative disease frequently managed with hospice support
`R99`	Ill-defined and unknown cause of mortality	Used when a precise terminal diagnosis is not established but hospice-level needs exist

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99221`	Initial hospital inpatient care, per day, for the evaluation and management of a patient	May be performed prior to hospice enrollment when patients are transitioning from inpatient status to hospice care
`99223`	Initial hospital care, high complexity	Used for complex hospital evaluations preceding hospice initiation when higher complexity admission is required
`99304`	Nursing facility admission for observation and care, typically 30 minutes	May be used for initial nursing facility assessments when coordinating hospice services in a SNF or LTC setting
`99324`	Domiciliary or rest home visit for new patient	Used for hospice admission visits when hospice initiates services in an assisted living or residential setting
`99497`	Advance care planning including the explanation and discussion of advance directives	Often occurs as part of hospice enrollment discussions documenting goals of care and advance directives

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Summary & Overview

HCPCS G9694: Hospice Services Used During Measurement Period