G9700 Hospice Use — HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS G9700: Hospice Use During Measurement Period

HCPCS Level II code G9700 denotes patients who received hospice services at any point during a measurement period. Nationally, capture of hospice use is important for quality measurement, care coordination, and population-level monitoring of end-of-life care patterns. Identifying hospice utilization affects performance metrics and informs payer and provider reporting on palliative care delivery.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical intent of the code, how hospice use is categorized for measurement, and the expected service settings where this code applies. The publication outlines benchmark concepts and policy-relevant considerations tied to hospice documentation and reporting, and summarizes the administrative role of the code within quality measurement frameworks.

This summary does not provide state-specific guidance. Data not available in the input for detailed payer-specific rates, associated taxonomies, ICD-10 diagnoses, related codes, or service-line mappings.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9700HCPCS Level IIhospicepalliative carequality measurementend-of-life careservice utilizationbilling

Billing Code Overview

HCPCS Level II code G9700 identifies patients who use hospice services any time during the measurement period. This measure flags use of hospice care and is used to capture end-of-life service utilization during a specified measurement window.

Service type: Hospice services (use of palliative and supportive care focused on comfort rather than curative treatment)
Typical site of service: Hospice settings, which may include inpatient hospice facilities, residential hospice programs, home hospice care, and hospice care delivered in other care settings where hospice services are provided.

Clinical & Coding Specifications

Clinical Context

A patient enrolled in hospice care receives services during the measurement period and is therefore captured by billing code G9700. Typical scenario: an 82-year-old patient with advanced metastatic lung cancer has transitioned from disease-directed therapy to hospice services at home. The hospice interdisciplinary team — including a hospice physician, registered nurse, social worker, and hospice aide — provides symptom management, psychosocial support, and end-of-life planning. The clinical workflow begins with hospice admission documentation, establishment of a Plan of Care, regular hospice visit notes, and billing of hospice services. During the measurement period, any encounter, claim, or administrative record indicating hospice eligibility or hospice service usage is documented and billed to the patient’s primary payer using G9700 to indicate the patient used hospice services during that period. Typical site of service is the patient’s residence (home hospice) or a hospice inpatient unit; service type is hospice care services (continuous home care, general inpatient care, routine home care, or respite care) as applicable.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When additional work or complexity for hospice-related procedures or documentation is substantial beyond typical hospice visit complexity.

HCPCS G8978: Mobility Assessment for Walking & Moving Around Functional Limitation

HCPCS-G2198-MEDICAL-REASON-NO-UNHEALTHY-ALCOHOL-SCREENING

HCPCS G2198: Documentation of Medical Reason for Not Screening for Unhealthy Alcohol Use

HCPCS-G8749-ABSENCE-SYSTEMIC-SIGNS-SYMPTOMS-MELANOMA-ASSESSMENT

HCPCS G8749: Absence of Signs or Symptoms of Systemic Spread of Melanoma

HCPCS-G9404-POST-DISCHARGE-NO-FOLLOW-UP-30-DAYS

HCPCS G9404: Patient Did Not Receive Follow-Up Within 30 Days After Discharge

HCPCS-G2154-TD-TDAP-VACCINE-HISTORY-NINE-YEAR-LOOKBACK

HCPCS G2154: td/tdap Vaccine Received Within Nine-Year Lookback

HCPCS-G2113-CHRONIC-PREDNISONE-THERAPY-STATUS

HCPCS G2113: Chronic Prednisone Therapy Status, Improved or Stable

HCPCS-G9157-TRANSESOPHAGEAL-DOPPLER-CARDIAC-OUTPUT-MONITORING

HCPCS G9157: Transesophageal Doppler Cardiac Output Monitoring

HCPCS-G8417-BMI-ABOVE-NORMAL-WITH-FOLLOW-UP-PLAN

HCPCS G8417: BMI Above Normal with Documented Follow-Up Plan

HCPCS-G8778-DIABETES-SCREENING-NOT-PERFORMED-MEDICAL-REASON

HCPCS G8778: Documentation of Medical Reason for Not Performing Diabetes Screening

HCPCS-G0032-ANTIPSYCHOTIC-MULTIPLE-PRESCRIPTIONS

HCPCS G0032: Two or More Antipsychotic Prescriptions for Serious Mental Illness

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`185H00000X`	Hospice and Palliative Medicine Physician	Physicians specializing in hospice/palliative care who certify and manage hospice patients.
`3336C0001X`	Hospice and Palliative Medicine Nurse Practitioner	Advanced practice clinicians providing hospice symptom management and primary hospice visits.
`163W00000X`	Registered Nurse	Nurses who provide nursing assessments, symptom management, and document hospice care.
`251S00000X`	Social Worker	Social workers providing psychosocial support, care planning, and bereavement services.
`330M00000X`	Home Health Aide	Certified aides providing personal care services in the home hospice setting.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z51.5`	Encounter for palliative care	Directly relevant when documenting palliative or hospice encounters and care planning.
`C34.90`	Malignant neoplasm of unspecified part of bronchus or lung, unspecified	Common terminal diagnosis leading to hospice enrollment for advanced lung cancer.
`C80.1`	Malignant (primary) neoplasm, unspecified	Used when a primary site is not specified but patient has terminal malignancy requiring hospice.
`I50.9`	Heart failure, unspecified	Advanced heart failure frequently leads to hospice services for symptom management.
`G30.9`	Alzheimer disease, unspecified	Late-stage dementia commonly results in hospice enrollment for comfort care.
`N18.6`	End stage renal disease	ESRD patients may elect hospice for comfort-focused care when dialysis is discontinued.
`J44.9`	Chronic obstructive pulmonary disease, unspecified	Advanced COPD with refractory symptoms often leads to hospice care.
`R99`	Ill-defined and unknown cause of mortality	Used in some administrative records when cause is not specified but hospice services are provided.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99341`	Home visit for the evaluation and management of a new patient, typically 21-30 minutes	Used when hospice physicians or clinicians perform initial home E/M visits for hospice admission and assessment.
`99347`	Home visit for the evaluation and management of an established patient, typically 2-9 minutes	Used for routine brief follow-up hospice visits at the patient’s residence.
`99377`	Physician-level domiciliary/skilled nursing facility visit, initial care or follow-up, typically 31 minutes	Used when hospice services are delivered in a nursing facility and physician-level visits are documented.
`99499`	Unlisted evaluation and management service	Used for hospice-related E/M or coordination services not otherwise described by standard CPT when justified in documentation.
`G0180`	Physician certification of hospice care (initial)	Used historically for hospice certification documentation; may be used in workflows to support hospice election and certification of terminal prognosis.

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