Summary & Overview
HCPCS G9805: Hospice Services During Measurement Period
HCPCS Level II code G9805 designates patients who receive hospice services at any point during a defined measurement period. As a patient-status code, it is used in quality measurement, reporting, and care coordination workflows to identify individuals with hospice utilization, which has implications for care planning, benefit coordination, and outcome measurement on a national scale. Major payers commonly aligned with analyses of this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
This publication explains what G9805 represents, where it is typically applied, and why it matters across payers and reporting programs. Readers will find concise benchmarks and measurement context for hospice-flagging codes, an overview of common billing and reporting considerations, and clinical context around hospice service delivery and settings. The brief also highlights policy and measurement implications for payers and providers concerned with end-of-life care capture and reporting. Data not available in the input for specific modifiers, taxonomies, or ICD-10 pairings is noted where applicable.
Billing Code Overview
HCPCS Level II code G9805 identifies patients who use hospice services any time during the measurement period. This code represents a patient-level status flag used to indicate hospice utilization during the specified measurement window.
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Service type: Hospice services and supportive end-of-life care
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Typical site of service: Hospice facilities, patient homes, and other settings where hospice care is delivered
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult with advanced, life-limiting illness (for example, metastatic cancer, end-stage heart failure, end-stage chronic obstructive pulmonary disease, or advanced neurodegenerative disease) who elects or is referred to hospice care during the measurement period. The patient may receive hospice services at home, in an assisted living facility, in a skilled nursing facility, or in an inpatient hospice unit. Clinical workflow: hospice eligibility is assessed by the attending physician and hospice medical director with documentation of a prognosis of six months or less if the disease follows its usual course; the hospice plan of care is initiated and documented in the medical record; billing staff capture service dates and apply the hospice billing indicator for the measurement period; quality measurement or reporting staff identify the patient as meeting the hospice-in-period measure when hospice services are recorded any time during the measurement period. Typical site of service: home hospice, hospice inpatient unit, skilled nursing facility, or assisted living residence. Common patient interactions: interdisciplinary team visits (nursing, social work, chaplain), admission and periodic assessments, symptom management visits, and bereavement follow-up after death.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased Procedural Services | Use when work required is substantially greater than typically required for the service documented, with supporting documentation. |