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    v1.0.28
    OpenPayerBilling CodesTemporary CodesHCPCS hcpcs-q5004-hospice-care-skilled-nursing-facility
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    HCPCS Level II Q5004: Hospice Care in Skilled Nursing Facility

    HCPCS Level II code Q5004 describes hospice care provided in a skilled nursing facility (SNF), representing hospice services delivered to patients residing in an SNF; the service type is hospice care, and the typical site of service is a skilled nursing facility (SNF), covering routine hospice visits and related multidisciplinary support provided onsite to hospice-eligible residents.

    For related coverage guidance, see recent payer policy updates: B-Hemolytic Streptococcus Testing, Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance Assays, Hepatitis Testing (A, B, C, D) Coverage Criteria.

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    Table of contents

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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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99304Initial nursing facility care, per day, for the evaluation and management of a patient, typically 20 minutesUsed when initial comprehensive E/M assessment is performed by a physician in the SNF prior to or at hospice admission.
    99307Subsequent nursing facility care, per day, for the evaluation and management of a patient, typically 10 minutesUsed for routine subsequent physician visits in the SNF for a hospice patient.
    99334Prolonged 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.
    96413Chemotherapy administration, intravenous infusion technique; up to 1 hourMay be used in rare cases when palliative chemotherapy is continued under hospice in SNF and is billable per payer rules.
    97602Removal of devitalized tissue (e.g., debridement), open wound, selective debridement, without anesthesiaCommonly provided by hospice or SNF nursing for complex wound care under hospice plan of care.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    56Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    163W00000XRegistered Nurse(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive…
    106E00000XAssistant Behavior AnalystAn assistant behavior analyst is qualified by Behavior Analyst Certification Board certification and/or a state-issued license or credential in behavi…
    2471C1106XCardiac-Interventional Technology Radiologic TechnologistA radiologic technologist who specializes in cardiac interventional and is appropriately educated and trained, consistent with nationally recognized s…
    133VN1401XPediatric Critical Care Nutrition Registered DietitianAn individual who is a Board Certified Specialist in Pediatric Critical Care Nutrition and applies evidence-based nutrition knowledge in providing med…
    291900000XMilitary Clinical Medical LaboratoryA Department of Defense (DoD) medical clinical reference laboratory not associated with a DoD Hospital or DoD Clinic. An example is the Armed Forces I…
    364SW0102XWomen's Health Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
    133VN1201XObesity and Weight Management Nutrition Registered DietitianAn individual who is a Board Certified Specialist for Obesity and Weight Management and educates, supports, and advocates for patients and clients to …
    237700000XHearing Instrument SpecialistIndividuals who test hearing for the selection, adaptation, fitting, adjusting, servicing, and sale of hearing aids. Hearing Instrument Specialist is …

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    C18.9Malignant neoplasm of colon, unspecified
    C25.9Malignant neoplasm of pancreas, unspecified
    C34.90Malignant neoplasm of unspecified part of unspecified bronchus or lung
    C50.911Malignant neoplasm of unspecified site of right female breast
    C61Malignant neoplasm of prostate
    C67.9Malignant neoplasm of bladder, unspecified
    C71.9Malignant neoplasm of brain, unspecified
    C80.1Malignant (primary) neoplasm, unspecified
    E11.65Type 2 diabetes mellitus with hyperglycemia
    F03.90Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety

    Showing 1–10 of 28

    Related Payer Policy Updates

    Specialty: Infectious Disease1 / 3

    10 rows

    PolicyPayerEffective Date
    B-Hemolytic Streptococcus TestingOscar Health2026-10-01
    Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance AssaysOscar Health2026-10-01
    Hepatitis Testing (A, B, C, D) Coverage CriteriaOscar Health2026-10-01
    Lyme Disease Testing Coverage CriteriaOscar Health2026-10-01
    Pathogen Panel TestingOscar Health2026-10-01
    Diagnostic Testing of Common Sexually Transmitted InfectionsOscar Health2026-10-01
    Testing for Diagnosis of Active or Latent TuberculosisOscar Health2026-10-01
    Testing for Vector-Borne InfectionsOscar Health2026-10-01
    Coronavirus Testing in the Outpatient SettingOscar Health2026-10-01
    Human Immunodeficiency Virus (HIV)blue cross blue shield - louisiana2026-09-15

    Related Codes

    HCPCS-LEVEL-II-Q4139-INJECTABLE-AMNIOMATRIX-BIODMATRIX-1-CC

    HCPCS Q4139: Amniomatrix or Biodmatrix, Injectable, 1 cc

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

    HCPCS Q4256: MLG-complete Skin Graft Material, Per Sq Cm

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

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

    HCPCS-Q0035-CARDIOKYMOGRAPHY-CARDIAC-MOTION-RECORDING

    HCPCS Level II Q0035: Cardiokymography

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

    HCPCS Level II Q0081: Infusion Therapy, Non‑Chemotherapeutic, Per Visit

    HCPCS-Q0083-CHEMOTHERAPY-NON-INFUSION-ADMINISTRATION

    HCPCS Q0083: Chemotherapy Administration, Non-Infusion Methods

    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 Infusion Plus Other Technique(s), Per Visit

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

    HCPCS Q0091: Screening Papanicolaou Smear Collection and Transport

    HCPCS-Q0092-PORTABLE-XRAY-EQUIPMENT-SETUP

    HCPCS Q0092: Set-up Portable X-ray Equipment

    Showing 1–10 of 629

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    Frequently Asked Questions

    References

    1. 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. 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. 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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    99499
    Unlisted evaluation and management service
    Used for hospice-specific or bundled interdisciplinary services not described by other CPT codes, per payer guidelines.