G9760 HCPCS Hospice — Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS G9760: Patients Using Hospice Services During Measurement Period

HCPCS Level II code G9760 denotes patients who used hospice services at any point during a measurement period. The code is used to flag hospice utilization in quality measurement, reporting, and administrative records, informing care coordination, end-of-life planning, and performance measurement across healthcare systems. Nationally, hospice utilization is a critical indicator for palliative care access, quality measurement, and program eligibility tracking.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how G9760 is applied across payers, relevant benchmark contexts, and the clinical setting implications for hospice identification. The publication summarizes payer coverage patterns and common administrative considerations for capturing hospice status during reporting periods.

The report also provides policy and measurement context: how hospice designation via G9760 affects quality metrics, reporting workflows, and potential impacts on care transitions. Clinical context addresses the role of hospice services in symptom management and end-of-life care planning. Where input data is missing, the publication notes that specific fields were not provided.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9760HCPCS Level IIhospicepalliative-carequality-measurementend-of-life-careservice-lineadministrative-coding

Billing Code Overview

HCPCS Level II code G9760 identifies patients who use hospice services any time during the measurement period. This code represents encounters or administrative records capturing hospice utilization for a patient within the specified reporting timeframe.

Service type: Hospice services, including palliative and supportive care focused on comfort and quality of life
Typical site of service: Hospice care settings, which may include inpatient hospice facilities, hospice units within hospitals, nursing homes, residential hospice programs, or home-based hospice care

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult with a terminal illness (for example, advanced metastatic cancer or end-stage heart failure) who elects comfort-focused care and is formally enrolled in a hospice program during the reporting/measurement period. The clinical workflow begins when the patient or family requests hospice evaluation or the treating clinician documents terminal prognosis and a transfer to hospice is initiated. The hospice admission includes an interdisciplinary assessment by hospice clinicians (physician, registered nurse, social worker, chaplain, hospice aide) and establishment of a plan of care focusing on symptom control, psychosocial support, and bereavement services. Billing and quality measurement teams capture hospice utilization by reporting the HCPCS Level II code G9760 to indicate the patient received hospice services any time during the measurement period. Typical sites of service include the patient’s residence (home or assisted living), hospice inpatient units, skilled nursing facilities when hospice services are provided, and hospital settings when continuous hospice care or inpatient hospice services are delivered. Common care activities surrounding this scenario include pain and symptom management visits, medication reconciliation, caregiver education, and coordination of community-based supports.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

HCPCS G9037: Interprofessional Tele/Internet/EHR Consultation, 30 Minutes

HCPCS-G0452-MOLECULAR-PATHOLOGY-PHYSICIAN-INTERPRETATION-REPORT

HCPCS G0452: Molecular Pathology Physician Interpretation and Report

HCPCS-G9821-CHLAMYDIA-SCREENING-NO-DOCUMENTATION-FOLLOW-UP

HCPCS G9821: No Documentation of Chlamydia Screening Test with Proper Follow-Up

HCPCS-G8783-NORMAL-BLOOD-PRESSURE-NO-FOLLOW-UP

HCPCS G8783: Normal Blood Pressure Reading, No Follow-Up Required

HCPCS-G9343-CT-PRIOR-IMAGING-SEARCH-NOT-CONDUCTED-RADIATION-PLANNING

HCPCS G9343: CT Prior Imaging Search Not Conducted for Radiation Planning

HCPCS-G9716-BMI-OUTSIDE-NORMAL-NO-FOLLOW-UP-DUE-TO-MEDICAL-REASON

HCPCS G9716: BMI Outside Normal, Follow-Up Not Completed for Medical Reason

HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

HCPCS G0009: Administration of Pneumococcal Vaccine

HCPCS-G2099-OLDER-PATIENTS-FRAILTY-ADVANCED-ILLNESS

HCPCS G2099: Patients 66+ with Frailty and Advanced Illness

HCPCS-G8708-PATIENT-NOT-PRESCRIBED-ANTIBIOTIC

HCPCS G8708: Patient Not Prescribed Antibiotic

HCPCS-G0164-NURSING-EDUCATION-HOME-HEALTH-HOSPICE

HCPCS G0164: Skilled Nursing Education by LPN/RN, Home Health/Hospice

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`208D00000X`	Hospice and Palliative Medicine Physician	Primary specialty responsible for hospice eligibility, plan of care, and certification of terminal prognosis.
`207P00000X`	Internal Medicine Physician	Common referring or attending physician managing chronic conditions and coordinating hospice referral.
`282N00000X`	Registered Nurse	Provides nursing assessment and symptom management during hospice enrollment.
`251S00000X`	Social Worker	Provides psychosocial assessment, caregiver support, and discharge/bereavement planning.
`364S00000X`	Certified Nurse Assistant / Home Health Aide (HHA)	Provides personal care and activities of daily living support in the home setting.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z51.5`	Encounter for palliative care	Frequently used to document palliative-focused management when hospice services are provided.
`C80.1`	Malignant (primary) neoplasm, unspecified; metastatic disease (when coded as appropriate)	Advanced cancer is a common diagnosis among hospice enrollees and often drives hospice eligibility.
`I50.9`	Heart failure, unspecified	End-stage heart failure is a common terminal diagnosis leading to hospice enrollment.
`J44.9`	Chronic obstructive pulmonary disease, unspecified	Advanced COPD with refractory symptoms is frequently associated with hospice care.
`N18.6`	End stage renal disease	ESRD patients may elect hospice for comfort-focused care when prognosis is limited.
`G30.9`	Alzheimer's disease, unspecified	Advanced dementia commonly results in hospice enrollment for comfort and supportive care.
`R99`	Ill-defined and unknown cause of mortality	Used rarely to describe severe decline when a specific terminal diagnosis is not fully defined but hospice services are provided.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99497`	Advance care planning including the explanation and discussion of advance directives, by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, parent, or surrogate	May be performed before or during hospice enrollment to document goals of care and advance directives.
`99324`	Domiciliary, rest home, or custodial care services, new patient; initial visit	Used for initial face-to-face assessments when hospice services begin in a residential or custodial setting.
`99347`	Home visit for established patient, typical face-to-face visit	Used for ongoing symptom management visits by physicians or advanced practice clinicians after hospice admission.
`99337`	Domiciliary, rest home, or assisted living facility services, established patient; longer visit (31 minutes or more)	Used for extended interdisciplinary visits addressing complex symptom or psychosocial needs in hospice patients.
`G0180`	Service performed by a physician or other qualified health care professional in the home; each 30 minutes of home health physical therapy, occupation therapy, or speech-language pathology	May be used for therapy visits provided in the home setting for hospice patients when clinically indicated.

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