Summary & Overview
HCPCS G9713: Patients Using Hospice Services During Measurement Period
HCPCS Level II code G9713 denotes patients who used hospice services at any point during a defined measurement period. This code matters nationally because hospice utilization affects quality reporting, care coordination, and population-level measurements of end-of-life care across payers and programs. Tracking hospice use with a discrete HCPCS Level II code supports consistent identification of this patient cohort for quality metrics, risk adjustment, and program evaluation.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how G9713 is applied in measurement contexts, common reporting use cases, and where this code fits within broader quality measurement and claims-based identification of hospice care. The publication outlines benchmarks and comparative perspectives where available, summarizes relevant policy and reporting considerations, and provides clinical context about hospice as a service type and typical sites where hospice care is provided. Data not available in the input for specific modifiers, taxonomies, ICD-10 mappings, or related codes are noted as such in detailed sections.
Billing Code Overview
HCPCS Level II code G9713 identifies patients who use hospice services any time during the measurement period. This code is used to capture instances where a patient received hospice care within the timeframe specified by a measurement program or quality reporting initiative.
-
Service type: Hospice care services during the measurement period
-
Typical site of service: Hospice settings, which may include inpatient hospice facilities, hospice units within hospitals, or hospice services provided in the home or residential settings
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult enrolled in hospice services during a defined measurement period, often near end of life due to advanced progressive illness such as metastatic cancer, end-stage heart failure, chronic obstructive pulmonary disease with respiratory failure, or advanced dementia. The clinical workflow centers on hospice admission, ongoing hospice interdisciplinary team visits (nursing, social work, chaplaincy), symptom management (pain, dyspnea, nausea), coordination of durable medical equipment and medications, and documentation of hospice eligibility and goals-of-care. Billing staff capture hospice enrollment status and submit the G9713 HCPCS Level II code to indicate that the patient used hospice services at any time during the measurement period; this is typically reported by hospice agencies, home health-hospice programs, inpatient hospice units, or hospital discharge teams when patients are enrolled in hospice. Clinical notes must document hospice start and stop dates, attending provider, primary terminal diagnosis, and services rendered to support quality measurement and payer reporting for Blue Cross Blue Shield, Aetna, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Rarely used with hospice reporting; applicable when an associated billed service required significantly greater resources. |