Summary & Overview
HCPCS S9126: Hospice Care in the Home, Per Diem
HCPCS Level II code S9126 denotes per diem hospice care provided in the home and captures routine, bundled hospice services delivered to patients opting for comfort-focused end-of-life care. Nationally, hospice per diem codes like S9126 are central to how payers and providers structure payment for interdisciplinary symptom management, psychosocial support, and palliative nursing services outside institutional settings.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of coverage considerations across major commercial payers and the Medicare program, typical sites of service, and common administrative elements tied to the code. The publication also outlines benchmark contexts and policy factors that affect use of per diem hospice codes, including rate-setting approaches and care delivery implications.
This summary equips billing professionals, hospice program administrators, and policy analysts with the clinical framing and payer scope for S9126, and signals areas where organizations commonly monitor utilization and compliance. Data not available in the input will be noted in relevant sections.
Billing Code Overview
HCPCS Level II code S9126 represents hospice care, in the home, billed on a per diem basis. This code describes a bundled daily hospice service provided to terminally ill patients who elect comfort-focused care rather than curative treatment.
Service type: Hospice care, routine home services
Typical site of service: Patient's home or place of residence
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a terminal illness (for example, advanced metastatic carcinoma, end-stage heart failure, or advanced chronic obstructive pulmonary disease) who elects hospice services for comfort-focused care at home. The hospice interdisciplinary team conducts an initial evaluation in the patient’s residence, establishes a per diem plan of care that includes nursing visits, medication management, psychosocial support, and caregiver teaching, and documents prognosis and goals of care. Daily or periodic visits by hospice nursing staff, social workers, chaplains, and aides are coordinated; the hospice agency bills a per diem using S9126 for routine hospice care in the home. The clinical workflow includes an initial hospice admission visit, creation and signing of the hospice certification and plan of care, ongoing home visits for symptom control and caregiver support, coordination with the patient’s primary care clinician and specialists, and documentation of any changes in condition that may alter the level of hospice care (e.g., escalation to continuous home care or general inpatient care).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier / standard service indicator | Use when no special modifier applies to the per diem hospice claim |