Summary & Overview
HCPCS S0255: Hospice Referral Visit by Nurse or Social Worker
HCPCS Level II code S0255 denotes a hospice referral visit conducted by a nurse, social worker, or other designated staff to advise patients and families about hospice care options. Nationally, the code identifies encounters that support end-of-life decision-making, transitions to hospice services, and coordination of care — activities with implications for quality measurement, discharge planning, and payer coverage policies. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
This publication provides a concise overview of the clinical context for S0255, typical sites of service, and which payers commonly address coverage for hospice referral counseling. Readers will find a summary of expected service characteristics, common modifiers and billing considerations (listed separately), and the types of benchmarks and policy updates usually relevant to hospice referral services. The document is intended for clinicians, billing professionals, and policy analysts seeking a national perspective on how hospice referral visits are coded and recognized across major payers. Data not available in the input are noted where applicable.
Billing Code Overview
HCPCS Level II code S0255 represents a hospice referral visit in which a nurse, social worker, or other designated staff member advises the patient and family about hospice care options. This service is typically performed as a counseling and care-coordination encounter focused on end-of-life care planning and education.
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Service type: Hospice referral counseling and patient/family education
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Typical site of service: Patient's residence, hospice facility, or other outpatient settings where hospice counseling is provided
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with advanced, life-limiting illness (for example, metastatic cancer, end-stage heart failure, or advanced chronic obstructive pulmonary disease) who has been identified by their primary clinician or hospital case manager as appropriate for hospice discussion. A hospice referral visit billed with S0255 is performed by a registered nurse, licensed clinical social worker, or designated hospice intake staff member. The workflow commonly includes: a clinician or care team initiates a hospice discussion and places a referral; hospice staff schedule a face-to-face visit in the patient’s residence or inpatient unit; the hospice clinician reviews prognosis, benefits and limitations of hospice care, location options, eligibility criteria, and next steps with the patient and family; psychosocial and spiritual needs are assessed; caregiver capacity and safety are evaluated; documentation of the visit, informed consent discussion, and plan for enrollment or follow-up is completed. Typical site of service is the patient’s home, long-term care facility, or inpatient unit. The visit focuses on counseling and care options rather than providing billable medical procedures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the hospice referral visit requires substantially greater work than typical due to complexity of counseling or coordination. |