Summary & Overview

HCPCS G9848: No Systemic Cancer-Directed Therapy in Last 14 Days of Life

HCPCS Level II code G9848 denotes that a patient did not receive systemic cancer-directed therapy in the last 14 days of life. As an end-of-life quality measure, the code is used to document avoidance of potentially nonbeneficial systemic treatment during the final two weeks of life, reflecting goals-of-care decisions and hospice or palliative care utilization. National attention to such measures has grown amid efforts to align cancer care with patient preferences and reduce low-value interventions near death.

Key payers included in coverage and benchmarking discussions are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for the measure, typical sites of service where the code is used (inpatient, hospice, and other end-of-life settings), and an outline of what analyses typically accompany this code: utilization benchmarks, reporting implications for quality programs, and implications for care coordination between oncology and palliative services.

This summary addresses national policy and clinical context rather than state-specific rules. Data not available in the input are noted where relevant; the publication focuses on the code definition, common reporting contexts, and the types of benchmarks and policy updates readers can expect to see when evaluating end-of-life cancer care quality.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9848HCPCS Level IIend-of-life careoncology quality measuresystemic therapy avoidancehospice and palliative careutilization benchmarkingquality reporting

Billing Code Overview

HCPCS Level II code G9848 indicates that a patient did not receive systemic cancer-directed therapy in the last 14 days of life. This measure documents the absence of systemic oncologic treatment during the final two weeks of a patient's life and is used to capture end-of-life care patterns for patients with cancer.

Service type: End-of-life oncology care quality measure
Typical site of service: Inpatient hospital, hospice, or other end-of-life care settings

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with advanced or metastatic cancer who has transitioned to comfort-focused care in an inpatient hospice unit or a hospital palliative care service. During the last 14 days of life the patient does not receive systemic cancer-directed therapy (no cytotoxic chemotherapy, targeted therapy, immunotherapy, or hormonal therapy). Clinical workflow includes review of the medication and treatment record by the palliative care team or hospice physician, documentation that systemic anticancer treatments were withheld in accordance with goals of care or clinical status, and coding of the encounter for quality measurement or reporting using billing code G9848. The documentation includes the patient’s diagnosis, decision-making notes regarding cessation or non-initiation of systemic therapy, dates of last treatment if applicable, and confirmation that no systemic cancer-directed therapy was administered within the final 14 days of life. Typical sites of service are inpatient hospice units, hospital inpatient services with palliative care consults, and long-term care facilities where end-of-life care is delivered.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When documentation supports substantially greater physician work related to complex end-of-life care coordination beyond typical service for the encounter.

Taxonomy Code	Specialty	Notes
`207P00000X`	Hospice and Palliative Medicine	Primary specialty managing end-of-life care and documentation for `G9848`.
`208D00000X`	Medical Oncology	Oncologists document cessation or non-administration of systemic cancer-directed therapy and provide last-treatment dates.
`207L00000X`	Hematology & Oncology	Relevant when hematologic malignancies are involved and systemic therapy decisions are made.
`261QM0800X`	Internal Medicine	Hospitalist or inpatient physician overseeing transition to comfort-focused care.
`363L00000X`	Certified Registered Nurse Anesthetist	Included when anesthesia-related modifiers are relevant to concurrent procedures, though uncommon for this metric.

CPT Code	Description	Relationship to This Procedure
`99221`	Initial hospital care, typically 30 minutes at bedside	Used for initial inpatient evaluation when goals-of-care discussions and decision to withhold systemic therapy are documented.
`99231`	Subsequent hospital care, typically 15 minutes	Used for daily follow-up visits documenting ongoing end-of-life management and confirmation of no systemic therapy.
`99497`	Advance care planning including the explanation and discussion of advance directives, first 30 minutes	Often billed when formal goals-of-care and code status conversations occur that document cessation of cancer-directed therapy.
`99377`	Physician certification/recertification for hospice care (inpatient or facility)	Used to certify eligibility for hospice services where withholding systemic therapy is part of the care plan.
`99324`	Domiciliary or rest home visit for established patient, typically 25 minutes	Relevant for hospice or long-term care settings where documentation that no systemic therapy was given in last 14 days is recorded.

OpenPayer