Summary & Overview
HCPCS Q5007: Hospice Care in Long Term Care Facility
HCPCS Level II code Q5007 designates hospice care provided to patients residing in long-term care facilities. This code captures hospice services delivered on-site within institutions such as nursing homes and skilled nursing facilities and is important for ensuring appropriate billing and coverage for end-of-life, palliative, and comfort-focused care in institutional settings. Nationally, accurate use of this code affects hospice program billing consistency and payer reimbursement for facility-based hospice services.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise benchmarks and policy context related to facility-based hospice billing, including payer coverage considerations and where Q5007 fits within hospice service lines. The publication outlines common clinical contexts for hospice in long-term care, typical site-of-service implications, and administrative considerations for claims submission.
The article provides a national view of the code’s purpose, operational implications for providers billing hospice services in long-term care settings, and a summary of what to expect from major commercial payers and Medicare regarding coverage and claims processing. Data not available in the input for detailed modifiers, associated taxonomies, ICD-10 pairings, and payer-specific rates are noted where applicable.
Billing Code Overview
HCPCS Level II code Q5007 represents hospice care provided in a long term care facility. This code denotes hospice services delivered to patients residing in institutional long-term care settings, such as skilled nursing facilities or nursing homes. The service type is hospice care, encompassing palliative and supportive services focused on comfort and quality of life rather than curative treatment. The typical site of service is the long term care facility where the patient resides.
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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.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |