Summary & Overview
HCPCS G9702: Hospice Services Utilization
HCPCS Level II code G9702 documents patients who receive hospice services at any point during a measurement period. As a utilization indicator, this code matters nationally for quality reporting, care coordination, and population health measurement because hospice enrollment affects care plans, resource allocation, and performance metrics across payers. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, the clinical context of hospice care, and how the code is used in reporting and measurement programs. The publication summarizes benchmark implications for payers, highlights common reporting scenarios, and outlines the administrative context in which G9702 is captured. The document also describes typical sites of service for hospice care and notes related reporting considerations. Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line are identified where relevant.
Billing Code Overview
HCPCS Level II code G9702 identifies patients who use hospice services any time during the measurement period. This code is used to indicate hospice utilization for a patient over a defined reporting window.
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Service type: Hospice services reporting
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Typical site of service: Hospice settings (including inpatient hospice units, hospice-certified facilities, and home hospice care)
Clinical & Coding Specifications
Clinical Context
A patient enrolled in hospice care is identified in the electronic health record as having received hospice services at any point during the measurement period. Typical patients are adults with terminal diagnoses such as advanced cancer, end-stage heart failure, progressive neurodegenerative disease, or end-stage chronic obstructive pulmonary disease who elect comfort-focused, palliative care rather than curative treatment. The clinical workflow begins with hospice admission documentation by a hospice physician or nurse practitioner, completion of the hospice plan of care, and recording of hospice claim(s) or encounter(s) in billing systems. During the measurement period the clinician documents hospice election, certification of terminal prognosis (generally six months or less if the disease follows its typical course), goals of care discussions, and any concurrent services provided. Payers review claims or hospice encounter data to identify patients meeting the hospice-use measure; quality reporting uses the presence of hospice service during the period as the measure event.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Rarely applicable; used when additional work beyond typical hospice-related evaluation is documented for a billable service that supports hospice care. |
23 |