G9740 Hospice Services HCPCS — Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS G9740: Hospice Services Any Time During Measurement Period

HCPCS Level II code G9740 identifies hospice services provided to a patient at any time during the measurement period. This designation matters nationally because hospice usage is a key quality and utilization measure for end-of-life care, impacting reporting, program evaluation, and coverage determinations across major payers. Tracking encounters coded with G9740 supports assessment of access to palliative services and alignment with value-based care goals.

Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national perspective on the clinical meaning of the code, typical service settings, and the policy and billing contexts where G9740 is applied. The publication summarizes benchmarks and reporting considerations, highlights policy updates affecting hospice measurement where applicable, and provides clinical context to clarify when hospice services are reflected by this code. Data not provided in the input (such as associated taxonomies, specific ICD-10 pairings, and utilization statistics) are noted where relevant.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9740HCPCS Level IIhospice careend-of-life carepalliative servicesmeasurement periodbilling and codingquality reporting

Billing Code Overview

HCPCS Level II code G9740 denotes hospice services provided to a patient at any time during the measurement period. The service type is hospice care, which encompasses palliative and supportive care focused on comfort for patients with terminal illness. The typical site of service is hospice setting or the patient’s residence, including inpatient hospice units, hospice-certified facilities, and home hospice care.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult or pediatric patient who received hospice services at any time during the measurement period. The patient usually has a terminal illness (for example, advanced cancer, end-stage heart failure, end-stage chronic obstructive pulmonary disease, or advanced neurodegenerative disease) and has been enrolled in a hospice program to receive palliative and comfort-focused care rather than curative treatments. The clinical workflow begins when the treating physician or interdisciplinary hospice team assesses eligibility, documents the patient’s terminal prognosis and goals of care, obtains hospice election forms, and initiates hospice services. Services documented under G9740 reflect that the patient received hospice care during the measurement period and may include home visits by hospice nurses, physician oversight, social work, spiritual care, symptom management, medication administration, durable medical equipment related to comfort, and coordination with primary or specialty clinicians. Billing typically originates from hospice providers (home hospice agencies, hospice units in hospitals or skilled nursing facilities) and is submitted to payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare as evidence of hospice utilization during the reporting period.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

HCPCS G4032: Rheumatology MIPS Specialty Set

HCPCS-G8949-DIET-PHYSICAL-ACTIVITY-COUNSELING-REFUSAL

HCPCS G8949: Documentation of Diet and Physical Activity Counseling Refusal

HCPCS-G8955-ASSESSMENT-ADEQUACY-VOLUME-MANAGEMENT

HCPCS G8955: Assessment of Adequacy of Volume Management

HCPCS-G2001-POST-DISCHARGE-IN-HOME-NEW-PATIENT-VISIT

HCPCS G2001: Post-Discharge In-Home Visit for New Patient

HCPCS-G0547-INTERPROFESSIONAL-MENTAL-HEALTH-E-CONSULT-11-20-MINUTES

HCPCS G0547: Interprofessional Mental Health E-Consult, 11–20 Minutes

HCPCS-G9960-DOCUMENTATION-SYSTEMIC-ANTIMICROBIAL-REASON

HCPCS G9960: Documentation of Medical Reason for Systemic Antimicrobials

HCPCS-G9786-DERMATOPATHOLOGY-REPORT-NOT-SENT-WITHIN-7-DAYS

HCPCS G9786: Pathology Report Not Sent for Cutaneous Skin Cancer within 7 Days

HCPCS-G9274-BLOOD-PRESSURE-ELEVATED-THRESHOLD

HCPCS G9274: Elevated Blood Pressure Measurement, Hypertensive Thresholds

HCPCS-G1000-CLINICAL-DECISION-SUPPORT-PATHWAYS-APPROPRIATE-USE-CRITERIA

HCPCS G1000: Clinical Decision Support Applying Appropriate Use Pathways

HCPCS-G0144-CERVICAL-VAGINAL-CYTOLOGY-AUTOMATED-THIN-LAYER-SCREENING

HCPCS G0144: Cervical or Vaginal Cytopathology Screening, Automated

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`251200000X`	Hospice and Palliative Medicine Physician	Physicians specializing in end-of-life care who certify and oversee hospice eligibility and plan of care.
`251K00000X`	Hospice and Palliative Medicine Nurse Practitioner	Advanced practice clinicians providing symptom management, medication management, and hospice visits.
`334N00000X`	Social Worker	Licensed social workers providing psychosocial assessment, counseling, and care coordination in hospice teams.
`363L00000X`	Chaplain/Spiritual Care Provider	Provides spiritual care and bereavement support as part of the interdisciplinary hospice team.
`261QM0800X`	Home Health Agency Provider	Agencies that operate hospice programs and submit claims for hospice services provided in the home or community settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C80.1`	Malignant neoplasm without specification of site, metastatic	Common terminal diagnosis leading to hospice enrollment for advanced cancer with limited prognosis.
`I50.9`	Heart failure, unspecified	End-stage heart failure frequently qualifies patients for hospice due to refractory symptoms and limited life expectancy.
`J44.9`	Chronic obstructive pulmonary disease, unspecified	Advanced COPD with recurrent exacerbations and progressive decline is a common hospice diagnosis.
`G30.9`	Alzheimer disease, unspecified	Advanced dementia with loss of function and failure to thrive is a standard hospice indication.
`F03.90`	Unspecified dementia without behavioral disturbance	Late-stage dementia often results in hospice enrollment for comfort-focused care.
`N18.6`	End stage renal disease	Patients with ESRD who forgo dialysis may receive hospice services for symptom control and comfort.
`A41.9`	Sepsis, unspecified organism	Severe, recurrent episodes or terminal sepsis in a chronically ill patient may lead to hospice care.
`R54`	Senility	Advanced frailty and failure to thrive in elderly patients commonly present during hospice enrollment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99221`	Initial hospital inpatient care, typically 30 minutes at bedside and on the patient’s hospital floor	May be used if hospice-eligible patients receive initial inpatient evaluation during a hospice-related admission before or during hospice enrollment.
`99341`	Home visit for a new patient, typically 20 minutes face-to-face	Used for home visits by clinicians providing hospice admission or initial assessments in the home setting.
`99347`	Home visit for established patient, typically 20 minutes face-to-face	Used for routine hospice follow-up home visits documenting ongoing palliative care and symptom management.
`99360`	Prolonged services in the home or nursing facility (first hour)	Used when hospice clinicians provide extended face-to-face time for complex symptom management or care coordination.
`99497`	Advance care planning including explanation and discussion of advance directives, first 30 minutes	May be performed as part of hospice enrollment discussions and documentation of goals of care.
`99406`	Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Occasionally used in counseling components of hospice care when relevant to patient comfort and symptom control.

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