Summary & Overview
HCPCS G9725: Hospice Services Use During Measurement Period
HCPCS Level II code G9725 denotes patients who used hospice services at any time during the measurement period. As a non-procedural, utilization-focused code, G9725 is commonly used in quality measurement and reporting to identify hospice engagement among patient populations. Nationally, capturing hospice use through a standardized HCPCS Level II code supports population health measurement, care coordination, end-of-life care analysis, and payer reporting requirements.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s meaning and clinical context, how hospice service encounters are classified for measurement purposes, and what to expect in payer reporting and benchmarking. The publication includes benchmark context, policy-relevant considerations for hospice capture in claims data, and implications for quality measurement and care coordination efforts.
This summary is intended for national audiences involved in billing, coding, quality measurement, and payer policy. It clarifies the purpose of G9725, the typical service settings where hospice care is delivered, and the kinds of analyses and reporting this code supports. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code G9725 identifies patients who use hospice services any time during the measurement period. This code is used to denote hospice utilization for quality measurement and reporting purposes rather than a specific clinical procedure.
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Service type: Hospice services and palliative care support provided during the measurement period
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Typical site of service: Hospice settings, which may include inpatient hospice units, hospice inpatient facilities, residential hospice homes, and hospice services delivered in the patient’s residence (home hospice)
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient receiving hospice services is identified for performance measurement during an annual quality review. Typical scenario: an 82-year-old patient with terminal metastatic lung cancer elects hospice care and is enrolled with a hospice provider mid-year. The clinical workflow includes hospice admission documentation, confirmation of hospice benefit enrollment in the medical record, coordination between hospice and the primary provider, and capture of the hospice status in claims using the hospice-specific HCPCS Level II code G9725. Clinical staff verify dates of hospice service, reconcile medications and advance care planning documentation, and flag the record for quality measurement that counts patients who used hospice services any time during the measurement period. The metric is used for reporting and quality assessments across payors including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Rarely applicable to G9725; would apply if unrelated services on the same claim required documentation of increased complexity |