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    v1.0.28
    OpenPayerBilling CodesTemporary CodesHCPCS hcpcs-q5007-hospice-care-long-term-care-facility
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    HCPCS Level II Q5007: Hospice Care in Long Term Care Facility

    HCPCS Level II code Q5007 describes hospice care provided in a long term care facility, representing services delivered to residents within nursing homes or similar long-term care settings; the service type is hospice care and the typical site of service is a long-term care facility where palliative and end-of-life supportive services are furnished to eligible patients.

    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 a frail elderly resident of a long-term care facility with a terminal illness (for example, advanced metastatic cancer, end-stage chronic obstructive pulmonary disease, or advanced dementia) who elects hospice services for comfort-focused care. The long-term care facility notifies the hospice provider when the resident’s decline accelerates, goals of care shift to palliation, and physician documentation supports hospice eligibility and an appropriate terminal prognosis. The hospice interdisciplinary team (physician, nurse, social worker, chaplain, hospice aide) conducts an initial hospice assessment on site, documents the plan of care, and provides ongoing visits to manage symptoms, medications, and caregiver support. Routine nursing visits, medication delivery, bereavement services, and periodic recertification assessments occur in the facility. Billing is submitted using the HCPCS Level II code Q5007 to indicate hospice care provided in a long-term care facility; associated modifiers may be appended when specific billing circumstances apply (for example, unusual services, cost-sharing, or split/shared visits). Clinical documentation includes certification/recertification forms, Plan of Care, progress notes, symptom management interventions, and records of visits to support medical necessity and level-of-care determinations.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99304Initial nursing facility care, per day, for the evaluation and management of a patient, typically 30 minutesMay be used by non-hospice clinicians for initial E/M when a resident in a long-term care facility is first evaluated prior to or concurrent with hospice admission.
    99307Subsequent nursing facility care, per day, for the evaluation and management of a patient, typically 20 minutesUsed for ongoing evaluation and management visits by clinicians providing facility-based care while hospice services continue.
    99214Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutesMay be used for outpatient-level problem-focused visits by physicians or advanced practice clinicians who document management related to the hospice plan of care.
    99499Unlisted evaluation and management serviceUsed for reporting miscellaneous or complex E/M or care coordination services in the hospice setting that do not map to a specific CPT code.
    99315Nursing facility discharge day management; 30 minutesUsed when a resident is discharged from the nursing facility or transferred from facility-based hospice care; documentation must support discharge management activities.

    Related Modifiers

    6 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…
    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…
    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
    251B00000XCase Management AgencyAn organization that is responsible for providing case management services. The agency provides services which assist an individual in gaining access…
    208D00000XGeneral Practice PhysicianA physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
    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…
    202D00000XIntegrative Medicine PhysicianA physician who specializes in the treatment of the whole person through prevention and treatment based on medical evidence. Integrative medicine cons…
    251T00000XPACE Provider OrganizationA PACE provider organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services(unique capitated manage…
    207PE0005XUndersea and Hyperbaric Medicine (Emergency Medicine) PhysicianA specialist who treats decompression illness and diving accident cases and uses hyperbaric oxygen therapy to treat such conditions as carbon monoxide…
    367H00000XAnesthesiologist AssistantAn individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants …
    246XS1301XSonography Specialist/Technologist CardiovascularA cardiovascular sonography technologist operates special equipment to create images and conduct tests of the cardiovascular system. They work with ph…

    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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