Summary & Overview

HCPCS G9993: Palliative Care Services Provided During Measurement Period

HCPCS Level II code G9993 denotes that a patient received palliative care services at any point during the measurement period. Nationally, this code captures provision of palliative care across care settings and is used in quality measurement and care coordination reporting. It matters for tracking access to symptom management, documenting supportive care encounters, and informing population-level measures of palliative service delivery.

Key payers covered in this summary include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical context and service settings, discussion of payer coverage patterns and common modifiers, and guidance on the types of benchmarks and policy topics typically associated with palliative care measurement. The publication summarizes how G9993 is used for reporting palliative care encounters, highlights typical sites of service, and identifies gaps where detailed taxonomy, diagnosis, and related code mappings are not available in the input.

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Billing Code Overview

HCPCS Level II code G9993 indicates that a patient was provided palliative care services any time during the measurement period. The service type is palliative care, focusing on symptom management, quality of life, and supportive care for patients with serious illness. The typical site of service is inpatient or outpatient clinical settings where palliative care teams or consultative services are provided, including hospital wards, specialty clinics, and hospice-coordinated care settings.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with advanced, progressive illness (for example, metastatic cancer, end-stage heart failure, or advanced chronic obstructive pulmonary disease) admitted to an inpatient hospice, hospital, or receiving outpatient home-based palliative care during the measurement period. The clinical workflow begins with identification of palliative needs by the primary team or outpatient clinician, followed by a consult or referral to a palliative care clinician (physician, nurse practitioner, or palliative care nurse). The palliative team conducts an initial comprehensive assessment addressing symptom management (pain, dyspnea, nausea), goals of care, psychosocial and spiritual needs, and family/caregiver support. Documentation includes history, symptom scores, goals-of-care discussion, plan of care, and care coordination notes. Services may be delivered in the inpatient hospital ward, outpatient clinic, home health visit, or hospice setting and can occur at any time during the measurement period. Billing uses G9993 to indicate that the patient received palliative care services during that performance interval.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when palliative consultation required substantially greater effort than usual (extensive counseling or coordination).
`23`	Unusual anesthesia	Use if unusual anesthesia circumstances occur during a palliative procedure that requires reporting anesthesia but the procedure was not planned for anesthesia.
`52`	Reduced services	Use when palliative services were partially reduced or not fully provided as originally planned.
`53`	Discontinued procedure	Use when a palliative procedure was started but halted due to patient condition or safety concerns.
`54`	Surgical care only	Rare for palliative billing; use when other providers bill post-operative palliative surgical care separately.
`55`	Postoperative management only	Use if another provider submits the principal operative service and palliative team bills only the postoperative management.
`56`	Preoperative management only	Use if the palliative team provided only preoperative optimization and another provider billed the surgery.
`62`	Two surgeons	Use when two surgeons with different specialties are required for a palliative-related operative intervention.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare patients	Use when services were furnished by a physician assistant, nurse practitioner, or clinical nurse specialist and Medicare-required reporting applies.
`QX`	CRNA service with medical direction by physician	Use when a Certified Registered Nurse Anesthetist provides anesthesia services under medical direction during a palliative procedure requiring anesthesia.

Taxonomy Code	Specialty	Notes
`251B00000X`	Palliative Medicine	Specialists providing comprehensive palliative consultations and longitudinal management.
`207P00000X`	Hospice and Palliative Medicine (Physician)	Physicians board-certified in hospice and palliative care who lead consults and goals-of-care discussions.
`363LP0808X`	Nurse Practitioner - Palliative Care	Nurse practitioners who perform assessments, symptom management, and billing under `AS` modifier rules when applicable.
`1744P0800X`	Pain Medicine	Pain specialists involved in complex symptom control or interventional pain procedures connected to palliative needs.
`103T00000X`	Social Worker	Licensed clinical social workers documenting psychosocial assessment and care coordination in palliative episodes.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C80.1`	Malignant neoplasm without specification of site, metastatic	Frequent indication for palliative care to manage symptoms and goals of care discussions in advanced cancer.
`I50.9`	Heart failure, unspecified	Advanced heart failure patients commonly require palliative care for symptom control and care planning.
`J44.9`	Chronic obstructive pulmonary disease, unspecified	COPD with advanced disease often triggers palliative interventions for dyspnea and symptom management.
`G30.9`	Alzheimer disease, unspecified	Progressive neurodegenerative disease prompting palliative support for cognitive decline and caregiver planning.
`N18.6`	End stage renal disease	ESRD patients may receive palliative services for symptom burden and dialysis decision-making.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99223`	Initial hospital care, typically 70 minutes or more	Often performed when a palliative medicine physician conducts a comprehensive initial inpatient consultation and documents medical decision-making and goals of care.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Used for outpatient palliative follow-up visits addressing symptom management and care planning.
`99497`	Advance care planning including explanation and discussion of advance directives, first 30 minutes	Performed when formal advance care planning discussions are billed during palliative care visits.
`99307`	Subsequent nursing facility care, per day, typically 35 minutes	Used when palliative care is delivered to patients in skilled nursing or long-term care facilities.
`99499`	Unlisted evaluation and management service	Used for atypical or bundled palliative care activities not represented by other CPT codes; documentation must justify use.