Summary & Overview
HCPCS G9995: Palliative Care Services, Any Time During Measurement Period
HCPCS Level II code G9995 denotes patients who received palliative care services at any point during a specified measurement period. This measure captures utilization of palliative care to identify populations receiving symptom management, advance care planning, and coordinated supportive services. Nationally, tracking palliative care use informs quality measurement, resource planning, and population health initiatives for patients with serious illness.
This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find an overview of how G9995 is defined, payer coverage considerations, and the clinical contexts in which the code is applied. The publication outlines benchmarking approaches and policy considerations relevant to palliative care measurement, and provides context for clinicians, coders, and policy stakeholders about where and when G9995 is typically used.
The content explains expected service settings for palliative care and the types of encounters the code represents. Where input data is incomplete, the publication notes that specific payer policy details, associated taxonomies, and related diagnosis coding were not provided in the source input and therefore are summarized at a high level. This resource is intended to inform national-level understanding of the measure and its implications for coverage and quality reporting.
Billing Code Overview
HCPCS Level II code G9995 represents patients who use palliative care services any time during the measurement period. The service type is palliative care services, which encompasses clinical and supportive care focused on symptom management, advance care planning, and coordination of care for patients with serious illness. The typical site of service is inpatient and outpatient settings where palliative care teams operate, including hospital-based palliative care consults, clinic-based palliative care visits, and home-based palliative care programs.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with advanced metastatic lung cancer and progressive functional decline is enrolled in outpatient palliative care services during a 12-month measurement period. The patient has frequent symptoms of dyspnea, pain, and anxiety and receives interdisciplinary palliative care focused on symptom management, goals-of-care discussions, advance care planning, and coordination with hospice when appropriate. The clinical workflow begins with referral from the oncology team to palliative care. An initial comprehensive palliative assessment is performed by a palliative care physician or nurse practitioner and documented in the medical record, including symptom scores, medication reconciliation, psychosocial needs, and advance directive status. Ongoing visits occur in the clinic, via home visits, or by telehealth; each visit documents care provided and whether palliative services were active during the measurement period. Care coordination notes and any transitions to hospice are recorded. Billing uses the HCPCS Level II code G9995 to indicate the patient received palliative care services at any point during the measurement year; clinical documentation supports the timing, provider, and services rendered for quality measurement and audit purposes.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when services require substantially greater work than typically required (e.g., extended complex palliative consultation beyond standard time when supporting documentation justifies). |