G9758 Hospice Indicator HCPCS — Reimbursement | OpenPayer

Summary & Overview

HCPCS G9758: Patient in Hospice During Measurement Period

HCPCS Level II code G9758 denotes that a patient was in hospice at any point during the measurement period. This indicator is used in quality measurement and reporting to capture hospice status for population management, care coordination, and outcome assessment. Nationally, accurate hospice designation affects reporting denominators and quality measure interpretation across payers and programs.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what G9758 represents clinically and administratively, how it is applied in measurement contexts, and where gaps in input data exist. The publication outlines benchmark implications, typical use cases in reporting, and the policy context around hospice status capture.

This summary is intended for administrators, coders, and policy analysts seeking a national perspective on hospice-status reporting. Data not available in the input is noted where applicable; the focus remains on the code meaning, service context, payer coverage, and the types of reporting or quality workflows that commonly rely on this hospice indicator.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9758HCPCS Level IIhospicequality measurementcare coordinationend-of-life careencounter reportingclinical documentation

Billing Code Overview

HCPCS Level II code G9758 indicates a patient in hospice at any time during the measurement period. This designation is used to identify patients who received hospice services during the reporting timeframe and is applied as a status indicator in quality measurement and encounter reporting.

Service type: Hospice care
Typical site of service: Hospice facility or patient residence (including home hospice)

Clinical & Coding Specifications

Clinical Context

A community hospice program documents patients who were enrolled in hospice at any time during the measurement period using billing code G9758. A typical patient is an older adult with advanced progressive illness (for example, metastatic cancer, end-stage heart failure, end-stage COPD, or advanced neurodegenerative disease) who elects comfort-focused care. The clinical workflow begins when the treating clinician or primary care provider refers the patient to hospice. Hospice eligibility is confirmed by documentation of a terminal prognosis (typically ≤6 months if the disease follows its usual course) and goals of care that prioritize comfort. The hospice interdisciplinary team — including hospice physician or medical director, nurse, social worker, chaplain, and aide — completes an admission assessment, documents the hospice start date in the medical record, and bills for hospice services. During the measurement period, any encounter, claim, or administrative record that confirms the patient was in hospice at any time is captured by G9758. Typical sites of service include the patient’s residence, assisted living facility, nursing facility, or inpatient hospice unit. Common scenario: an 82-year-old patient with C80.1 (malignant neoplasm, unspecified) and progressive functional decline elects hospice; hospice admission is documented on 03/15 and hospice care is provided across home visits and telephonic follow-up through the measurement year.

Coding Specifications

Modifier	Description	When to Use

HCPCS G9542: Re-assessment of Filter Removal Appropriateness within 3 Months

HCPCS-G9501-RADIATION-EXPOSURE-INDICES-NOT-DOCUMENTED-FLUOROSCOPY

HCPCS G9501: Radiation Exposure Indices Not Documented for Fluoroscopy

HCPCS-G8458-HEPATITIS-C-GENOTYPE-TEST-INELIGIBILITY-DOCUMENTATION

HCPCS G8458: Documentation of Ineligibility for Hepatitis C Genotype Testing

HCPCS-G0138-INTRAVENOUS-CIPAGLUCOSIDASE-ALFA-ATGA-INFUSION

HCPCS G0138: Intravenous Infusion of Cipaglucosidase Alfa-atga

HCPCS-G2015-COMPREHENSIVE-HOME-CARE-PLAN-OVERSIGHT-60MIN

HCPCS G2015: Comprehensive 60-Min Home Care Plan Oversight

HCPCS-G6013-RADIATION-TREATMENT-MULTIPLE-AREAS-11-19-MEV

HCPCS G6013: Radiation Treatment Delivery to 3+ Areas, 11–19 MeV

HCPCS-G9161-SPOKEN-LANGUAGE-COMPREHENSION-DISCHARGE

HCPCS G9161: Spoken Language Comprehension at Therapy Discharge

HCPCS-G9130-MULTIPLE-MYELOMA-DISEASE-STATUS-STAGING

HCPCS G9130: Multiple Myeloma Disease Status Assessment

HCPCS-G0553-DIGITAL-MENTAL-HEALTH-TREATMENT-MANAGEMENT-20-MIN

HCPCS G0553: Digital Mental Health Treatment Management, First 20 Minutes

HCPCS-LEVEL-II-G9734-PATIENT-REFUSED-PARTICIPATION

HCPCS Level II G9734: Patient Refused to Participate

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`350200000X`	Hospice and Palliative Medicine	Primary specialty coordinating hospice eligibility and care.
`363L00000X`	Registered Nurse	Nurses perform hospice assessments, care coordination, and home visits.
`251S00000X`	Social Worker	Provides psychosocial assessment and bereavement planning for hospice patients.
`163W00000X`	Physical Therapist	Provides supportive rehabilitative and comfort-focused therapy as needed in hospice.
`372N00000X`	Chaplain or Spiritual Care Counselor	Provides spiritual care and support aligned with hospice goals.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C80.1`	Malignant neoplasm, unspecified	Common terminal diagnosis prompting hospice enrollment for symptom management and comfort care.
`I50.9`	Heart failure, unspecified	Advanced heart failure is a frequent hospice diagnosis when refractory to disease-directed therapy.
`J44.9`	Chronic obstructive pulmonary disease, unspecified	End-stage COPD with progressive respiratory failure commonly leads to hospice referral.
`G30.9`	Alzheimer disease, unspecified	Advanced dementia with loss of function and poor prognosis is a common reason for hospice care.
`N18.6`	End stage renal disease	Patients who decline dialysis or for whom dialysis is no longer beneficial may elect hospice.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99306`	Subsequent nursing facility care, per day, for the evaluation and management of a patient	Used when hospice-enrolled patients receive daily or periodic facility-based E/M visits while in a nursing facility.
`99324`	Domiciliary or rest home visit for the evaluation and management of a new patient	Used for hospice admission visits performed in assisted living or domiciliary settings.
`99356`	Prolonged service in the inpatient setting, first hour	Used when hospice physicians provide extended face-to-face care or complex management beyond typical visit time.
`99341`	Home visit for the evaluation and management of a new patient	Used for initial hospice admission visits conducted in the patient’s home.
`99499`	Unlisted evaluation and management service	Used for hospice-specific services or care coordination activities not described by a standard CPT code and requiring payer determination.

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