G9720 Hospice Services (HCPCS) Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS G9720: Hospice Services During Measurement Period

HCPCS Level II code G9720 identifies patients who received hospice services at any time during the measurement period. As a marker of end-of-life care engagement, this code matters nationally for quality measurement, beneficiary care coordination, and reporting of hospice utilization across payer programs. It is commonly used in quality and population health reporting to flag hospice enrollment for patients who may have shifted goals of care.

Key payers included in this coverage set are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what G9720 denotes, how it maps to hospice service delivery and typical sites of service, and which payers commonly record the code. The publication also summarizes benchmarks and policy context relevant to hospice documentation and reporting, and highlights clinical context regarding measurement-period capture of hospice encounters.

This resource is intended for billing managers, quality leaders, and policy analysts seeking a national-level reference for G9720, covering reporting implications, payer relevance, and the operational meaning of hospice service capture during measurement periods. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9720HCPCS Level IIhospicequality-measurementend-of-life-careservice-capturemeasurement-periodpopulation-health

Billing Code Overview

HCPCS Level II code G9720 represents hospice services for a patient occurring at any time during the measurement period. This code is used to indicate that a patient received hospice care within the reporting timeframe.

Service type: Hospice care services provided to the patient during the measurement period
Typical site of service: Hospice settings, which may include inpatient hospice facilities, hospice inpatient units, hospice-run residential settings, or hospice services delivered in the home

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult or pediatric patient enrolled in a hospice program who received any hospice services during the measurement period. Commonly the patient has a terminal diagnosis such as advanced metastatic cancer, end-stage heart failure, end-stage chronic obstructive pulmonary disease, advanced neurodegenerative disease (for example, amyotrophic lateral sclerosis or advanced dementia), or other life-limiting illnesses. Hospice services are provided by an interdisciplinary team that may include physicians, nurse practitioners, registered nurses, social workers, chaplains, hospice aides, and volunteers.

Workflow: The patient or their proxy elects hospice care and is admitted to a hospice program. The hospice team documents the election in the medical record, performs an initial comprehensive assessment, creates and updates a hospice care plan, and provides ongoing visits and symptom management. Services may occur in the patients home, a skilled nursing facility, an inpatient hospice unit, or a hospital if concurrent or subsequent hospice care is authorized. Billing for hospice services is captured with the hospice HCPCS Level II code G9720 to indicate that hospice services occurred at any time during the measurement period. Clinical documentation includes the hospice election, dates of service, interdisciplinary team notes, advance care planning discussions, and symptom management interventions.

Coding Specifications

Modifier	Description	When to Use
`22`

HCPCS G9376: Retina Attached at 6-Month Follow-Up After One Surgery

HCPCS-G0525-DEMENTIA-DYAD-MANAGEMENT-MODERATE-COMPLEXITY

HCPCS G0525: Management of Dementia Patient-Caregiver Dyad, Moderate Complexity

HCPCS-G6004-RADIATION-TREATMENT-6-10-MEV-SINGLE-PORT-SIMPLE-BLOCKS

HCPCS G6004: Radiation Treatment Delivery, 6–10 MeV, Single Port or Parallel Opposed Ports

HCPCS-G0085-EXTENSIVE-CARE-MANAGEMENT-HOME-VISIT-75MIN

HCPCS G0085: Extensive Care Management Home Visit, 75 Minutes

HCPCS-G9726-PATIENT-REFUSED-TO-PARTICIPATE

HCPCS G9726: Patient Refused to Participate

HCPCS-G9891-MDPP-EXPANDED-MODEL-SESSION-REPORTING

HCPCS G9891: MDPP Expanded Model Session Reporting

HCPCS-G8738-LEFT-VENTRICULAR-EJECTION-FRACTION-LVEF-LESS-THAN-40

HCPCS G8738: Left Ventricular Ejection Fraction < 40%

HCPCS-G1015-CLINICAL-DECISION-SUPPORT-MEDICAL-GROUP

HCPCS G1015: Clinical Decision Support Mechanism, Medical Group

HCPCS-G9988-PALLIATIVE-CARE-SERVICES-MEASUREMENT-PERIOD

HCPCS G9988: Palliative Care Services During Measurement Period

HCPCS-G0056-OPTIMIZING-CHRONIC-DISEASE-MANAGEMENT-MIPS-VPW

HCPCS G0056: Optimizing Chronic Disease Management MIPS Value Pathways

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`185H00000X`	Hospice and Palliative Medicine Physician	Primary physician specialty overseeing hospice care and face-to-face encounters for hospice eligibility.
`367500000X`	Registered Nurse	Provides clinical assessments, symptom management, and nursing visits in hospice care.
`251S00000X`	Social Worker	Provides psychosocial assessment, counseling, and bereavement services.
`335800000X`	Chaplain/Spiritual Counselor	Provides spiritual care and support for patients and families in hospice.
`213E00000X`	Nurse Practitioner	Provides medical management, medication adjustments, and certifies eligibility when applicable.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C80.1`	Malignant neoplasm, unspecified, with metastasis	Common terminal oncologic diagnosis leading to hospice enrollment for symptom management and end-of-life care.
`I50.84`	End-stage heart failure	Typical diagnosis for hospice when advanced heart failure no longer responds to curative treatment.
`J96.01`	Acute respiratory failure with hypoxia	May be present in patients transitioning to hospice for goals-of-care change and symptom-focused management.
`G12.21`	Amyotrophic lateral sclerosis	Progressive neurodegenerative disease frequently resulting in hospice care for advanced-stage patients.
`F03.90`	Unspecified dementia without behavioral disturbance	Advanced dementia is a common reason for hospice enrollment focused on comfort care.
`N18.6`	End stage renal disease	ESRD patients may elect hospice when dialysis is discontinued or no longer beneficial.
`K72.90`	Hepatic failure, unspecified, without coma	Advanced liver failure can prompt hospice services for symptom control and palliative goals.
`R99`	Ill-defined and unknown cause of mortality	Used in end-of-life documentation contexts when specific cause is pending or unspecified.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Used for routine outpatient clinician visits to assess symptom control and hospice care needs.
`99304`	Nursing facility care, per day, for the evaluation and management of a resident — typically for initial nursing facility hospice assessments (days 1–20)	Used when hospice services are provided to a patient residing in a skilled nursing facility.
`99307`	Home visit for the evaluation and management of an established patient, typically 35 minutes	Used for in-home visits by clinicians providing hospice care and symptom management.
`99497`	Advance care planning including the explanation and discussion of advance directives, first 30 minutes	Used when hospice clinicians conduct formal advance care planning sessions with patients or surrogates.
`99509`	Hospice care supervision per diem, general inpatient level of care may be billed under hospice benefit rules (note: payer-specific rules apply)	Used in the context of documenting and billing levels of hospice care; coordinates with `G9720` reporting that hospice services occurred during the measurement period.

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