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HCPCS Level II Q5004: Hospice Care in Skilled Nursing Facility

HCPCS Level II code Q5004 designates hospice care provided in a skilled nursing facility (SNF). It identifies services and care coordination for patients receiving end-of-life support while residing in an SNF, a setting where facility-level skilled nursing and hospice interdisciplinary services overlap. Nationally, accurate use of this code matters for proper patient classification, facility billing, and ensuring hospice services are tracked across post-acute settings.

Key payers typically involved in coverage of hospice services include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what Q5004 represents, common modifiers associated with billing for complex scenarios, payer coverage considerations, and the clinical context for hospice delivered in SNFs. The publication outlines benchmarks and policy-relevant issues affecting hospice care in post-acute facilities, clarifies typical sites of service, and summarizes operational implications for providers and billing staff.

The analysis is national in scope and focuses on coding clarity, payer applicability, and clinical-service alignment for hospice in skilled nursing facilities.

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Billing Code Overview

HCPCS Level II code Q5004 represents hospice care provided in a skilled nursing facility (SNF). This service type is hospice care delivered in the skilled nursing facility setting, where patients receive end-of-life and palliative services while residing in an SNF. Typical site of service: skilled nursing facility.

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HCPCS Level II Q5004: Hospice Care in Skilled Nursing Facility

The analysis is national in scope and focuses on coding clarity, payer applicability, and clinical-service alignment for hospice in skilled nursing facilities.

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Get alerted when payer policies referencing Q5004 are released or updated.

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Billing Code Overview

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Clinical & Coding Specifications

Clinical Context

A typical patient is an elderly resident of a skilled nursing facility (SNF) with advanced, life-limiting illness such as metastatic cancer, end-stage heart failure, chronic obstructive pulmonary disease with respiratory failure, or advanced dementia. The patient has elected or been determined eligible for hospice services and requires comprehensive symptom management, psychosocial support, and skilled nursing oversight while remaining in the SNF.

The clinical workflow begins with the hospice interdisciplinary team (physician, hospice nurse, social worker, and chaplain) coordinating with the SNF clinical staff and the patient’s surrogate decision-maker to establish goals of care and confirm hospice eligibility. The hospice physician or medical director certifies terminal prognosis and documents face-to-face encounter as required. Hospice nursing performs ongoing skilled visits for symptom assessment and medication management, provides wound care or complex catheter care as needed, and coordinates with the SNF for any skilled procedures or therapies that are consistent with the hospice plan of care. Social work and spiritual care provide counseling and bereavement planning. All services delivered in the SNF under the hospice election are billed under the hospice payer rules; Q5004 is used to denote hospice care provided in the skilled nursing facility setting when applicable per payer billing guidance. Clinical documentation includes hospice election forms, face-to-face certification notes, interdisciplinary plan-of-care updates, skilled nursing visit notes, medication administration records, and communication with the SNF nursing staff and attending physician.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when a hospice-related skilled visit required substantially greater resources or complexity than typical, documented and justified.
`23`	Unusual anesthesia	Use if an unusual circumstance requires anesthesia for a hospice-related procedure billed concurrently (rare in SNF hospice context).
`52`	Reduced services	Use when hospice provides a service that is partially reduced or not completed as originally planned, documented appropriately.
`53`	Discontinued procedure	Use when a hospice-ordered skilled intervention is started but discontinued for patient safety or clinical reasons.
`54`	Surgical care only	Rare for hospice SNF billing; use only if surgical responsibility is transferred and separately reportable.
`55`	Postoperative management only	Use if hospice is billing for postoperative management services distinct from the operative event.
`56`	Preoperative management only	Use when hospice documents preoperative preparation services billed separately from surgery.
`62`	Two surgeons	Use when two distinct surgeons provide concurrent operative services and separate billing is required.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when applicable assistant-at-surgery services are provided and reported per payer rules.
`CQ`	Service performed in a facility by a registered nurse under a physician's order (Medicare hospice context)	Use for certain nursing services provided under hospice in facility settings per payer guidance.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Use when medical direction of concurrent anesthesia services is documented.
`QX`	Qualified nonphysician anesthetist with medical direction by a physician	Use when a CRNA provides anesthesia under physician direction associated with a hospice-related procedure.
`QY`	Medical direction of one certified registered nurse anesthetist by an anesthesiologist	Use when medical direction for CRNA is provided in a hospice-related operative event.
`SH`	Physician assistant services with direct supervision of a physician in surgical setting	Use when a PA provides services under direct physician supervision in connection with an operative or procedural event.

Taxonomy Code	Specialty	Notes
`163W00000X`	Hospice and Palliative Medicine	Primary specialty overseeing hospice care in SNF.
`163L00000X`	Geriatric Medicine	Commonly involved for complex elderly patients in SNF hospice.
`185H00000X`	Nursing — Hospice and Palliative	Hospice registered nurses providing skilled nursing visits in SNF.
`173E00000X`	Social Worker	Hospice social workers providing counseling and care coordination.
`211N00000X`	Chaplain / Spiritual Care	Spiritual care providers included in the interdisciplinary team.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C80.1`	Malignant neoplasm without specification of site, with metastasis	Common indication for hospice when disease is advanced and prognosis is limited; SNF hospice provides symptom management.
`I50.33`	Acute on chronic diastolic (congestive) heart failure	End-stage heart failure often results in hospice enrollment and SNF-based management.
`J44.9`	Chronic obstructive pulmonary disease, unspecified	Advanced COPD with respiratory failure commonly requires hospice services in SNF.
`F03.90`	Unspecified dementia without behavioral disturbance	Advanced dementia residents in SNF frequently receive hospice for comfort-focused care.
`G30.9`	Alzheimer disease, unspecified	Progressive cognitive decline leading to hospice election in SNF.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99304`	Initial nursing facility care, per day, for the evaluation and management of a patient, typically 20 minutes	Used when initial comprehensive E/M assessment is performed by a physician in the SNF prior to or at hospice admission.
`99307`	Subsequent nursing facility care, per day, for the evaluation and management of a patient, typically 10 minutes	Used for routine subsequent physician visits in the SNF for a hospice patient.
`99334`	Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour (list separately in addition to office/outpatient evaluation and management)	Used when prolonged hospice clinician visits in the SNF require additional time beyond standard E/M.
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour	May be used in rare cases when palliative chemotherapy is continued under hospice in SNF and is billable per payer rules.
`97602`	Removal of devitalized tissue (e.g., debridement), open wound, selective debridement, without anesthesia	Commonly provided by hospice or SNF nursing for complex wound care under hospice plan of care.
`99499`	Unlisted evaluation and management service	Used for hospice-specific or bundled interdisciplinary services not described by other CPT codes, per payer guidelines.

HCPCS Level II Q4139: Injectable Amniomatrix or Biodmatrix, 1 cc

HCPCS-LEVEL-II-Q4256-AREA-BASED-PROCEDURAL-ADD-ON-PER-SQ-CM

HCPCS Level II Q4256: Area-Based Procedural Add-On, Per sq cm

HCPCS-LEVEL-II-Q5132-ADALIMUMAB-AFZB-ABRILADA-10MG-INJECTION

HCPCS Level II Q5132: Adalimumab-afzb (Abrilada) 10 mg Injection

HCPCS-Q0035-CARDIOKYMOGRAPHY-CARDIAC-MOTION-RECORDING

HCPCS Q0035: Cardiokymography, Cardiac Motion Recording

HCPCS-Q0081-INFUSION-THERAPY-NON-CHEMOTHERAPEUTIC-PER-VISIT

HCPCS Q0081: Infusion Therapy, Non-Chemotherapeutic, Per Visit

HCPCS-Q0083-CHEMOTHERAPY-NON-INFUSION-ADMINISTRATION

HCPCS Q0083: Chemotherapy Administration, Non-Infusion

HCPCS-Q0084-CHEMOTHERAPY-INFUSION-ADMINISTRATION-PER-VISIT

HCPCS Q0084: Chemotherapy Infusion Administration, Per Visit

HCPCS-Q0085-CHEMOTHERAPY-INFUSION-PLUS-OTHER-TECHNIQUES-PER-VISIT

HCPCS Q0085: Chemotherapy Administration, Infusion Plus Other Technique(s) per Visit

HCPCS-Q0091-PAP-SMEAR-SPECIMEN-COLLECTION-TRANSPORT

HCPCS Q0091: Screening Pap Smear Specimen Collection and Transport

HCPCS-Q0092-PORTABLE-XRAY-EQUIPMENT-SETUP

HCPCS Q0092: Set-up of Portable X-Ray Equipment

Showing 1–10 of 629

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when a hospice-related skilled visit required substantially greater resources or complexity than typical, documented and justified.
`23`	Unusual anesthesia	Use if an unusual circumstance requires anesthesia for a hospice-related procedure billed concurrently (rare in SNF hospice context).
`52`	Reduced services	Use when hospice provides a service that is partially reduced or not completed as originally planned, documented appropriately.
`53`	Discontinued procedure	Use when a hospice-ordered skilled intervention is started but discontinued for patient safety or clinical reasons.
`54`	Surgical care only	Rare for hospice SNF billing; use only if surgical responsibility is transferred and separately reportable.
`55`	Postoperative management only	Use if hospice is billing for postoperative management services distinct from the operative event.
`56`	Preoperative management only	Use when hospice documents preoperative preparation services billed separately from surgery.
`62`	Two surgeons	Use when two distinct surgeons provide concurrent operative services and separate billing is required.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when applicable assistant-at-surgery services are provided and reported per payer rules.
`CQ`	Service performed in a facility by a registered nurse under a physician's order (Medicare hospice context)	Use for certain nursing services provided under hospice in facility settings per payer guidance.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Use when medical direction of concurrent anesthesia services is documented.
`QX`	Qualified nonphysician anesthetist with medical direction by a physician	Use when a CRNA provides anesthesia under physician direction associated with a hospice-related procedure.
`QY`	Medical direction of one certified registered nurse anesthetist by an anesthesiologist	Use when medical direction for CRNA is provided in a hospice-related operative event.
`SH`	Physician assistant services with direct supervision of a physician in surgical setting	Use when a PA provides services under direct physician supervision in connection with an operative or procedural event.

Taxonomy Code	Specialty	Notes
`163W00000X`	Hospice and Palliative Medicine	Primary specialty overseeing hospice care in SNF.
`163L00000X`	Geriatric Medicine	Commonly involved for complex elderly patients in SNF hospice.
`185H00000X`	Nursing — Hospice and Palliative	Hospice registered nurses providing skilled nursing visits in SNF.
`173E00000X`	Social Worker	Hospice social workers providing counseling and care coordination.
`211N00000X`	Chaplain / Spiritual Care	Spiritual care providers included in the interdisciplinary team.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C80.1`	Malignant neoplasm without specification of site, with metastasis	Common indication for hospice when disease is advanced and prognosis is limited; SNF hospice provides symptom management.
`I50.33`	Acute on chronic diastolic (congestive) heart failure	End-stage heart failure often results in hospice enrollment and SNF-based management.
`J44.9`	Chronic obstructive pulmonary disease, unspecified	Advanced COPD with respiratory failure commonly requires hospice services in SNF.
`F03.90`	Unspecified dementia without behavioral disturbance	Advanced dementia residents in SNF frequently receive hospice for comfort-focused care.
`G30.9`	Alzheimer disease, unspecified	Progressive cognitive decline leading to hospice election in SNF.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99304`	Initial nursing facility care, per day, for the evaluation and management of a patient, typically 20 minutes	Used when initial comprehensive E/M assessment is performed by a physician in the SNF prior to or at hospice admission.
`99307`	Subsequent nursing facility care, per day, for the evaluation and management of a patient, typically 10 minutes	Used for routine subsequent physician visits in the SNF for a hospice patient.
`99334`	Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour (list separately in addition to office/outpatient evaluation and management)	Used when prolonged hospice clinician visits in the SNF require additional time beyond standard E/M.
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour	May be used in rare cases when palliative chemotherapy is continued under hospice in SNF and is billable per payer rules.
`97602`	Removal of devitalized tissue (e.g., debridement), open wound, selective debridement, without anesthesia	Commonly provided by hospice or SNF nursing for complex wound care under hospice plan of care.
`99499`	Unlisted evaluation and management service	Used for hospice-specific or bundled interdisciplinary services not described by other CPT codes, per payer guidelines.

HCPCS Level II Q4139: Injectable Amniomatrix or Biodmatrix, 1 cc

HCPCS-LEVEL-II-Q4256-AREA-BASED-PROCEDURAL-ADD-ON-PER-SQ-CM

HCPCS Level II Q4256: Area-Based Procedural Add-On, Per sq cm

HCPCS-LEVEL-II-Q5132-ADALIMUMAB-AFZB-ABRILADA-10MG-INJECTION

HCPCS Level II Q5132: Adalimumab-afzb (Abrilada) 10 mg Injection

HCPCS-Q0035-CARDIOKYMOGRAPHY-CARDIAC-MOTION-RECORDING

HCPCS Q0035: Cardiokymography, Cardiac Motion Recording

HCPCS-Q0081-INFUSION-THERAPY-NON-CHEMOTHERAPEUTIC-PER-VISIT

HCPCS Q0081: Infusion Therapy, Non-Chemotherapeutic, Per Visit

HCPCS-Q0083-CHEMOTHERAPY-NON-INFUSION-ADMINISTRATION

HCPCS Q0083: Chemotherapy Administration, Non-Infusion

HCPCS-Q0084-CHEMOTHERAPY-INFUSION-ADMINISTRATION-PER-VISIT

HCPCS Q0084: Chemotherapy Infusion Administration, Per Visit

HCPCS-Q0085-CHEMOTHERAPY-INFUSION-PLUS-OTHER-TECHNIQUES-PER-VISIT

HCPCS Q0085: Chemotherapy Administration, Infusion Plus Other Technique(s) per Visit

HCPCS-Q0091-PAP-SMEAR-SPECIMEN-COLLECTION-TRANSPORT

HCPCS Q0091: Screening Pap Smear Specimen Collection and Transport

HCPCS-Q0092-PORTABLE-XRAY-EQUIPMENT-SETUP

HCPCS Q0092: Set-up of Portable X-Ray Equipment

Showing 1–10 of 629

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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HCPCS Level II Q5004: Hospice Care in Skilled Nursing Facility

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Billing Code Overview

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HCPCS Level II Q5004: Hospice Care in Skilled Nursing Facility

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References