CurrentPremera BluecrossPolicy N/A

Hospice and Palliative Care Exclusions

Defines hospice and palliative care coding and notes exclusions from certain quality measures (HEDIS, PQA) and lists applicable lines of business (Commercial, Medicare). Affects providers submitting claims and quality measure reporters.

Policy Summary

PayerPremera Bluecross

PolicyHospice and Palliative Care Exclusions

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionRefer to the Quality and Coding Tools Tip Sheets to determine measure-specific exclusions for patients receiving palliative care or in hospice.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2Lines of business listed

multipleCode mentions

HEDIS/PQAQuality programs referenced

Exclusions and Applicability

Exclusions and applicability

Quality measure exclusions and applicable lines of business.

ALL of the following

Exclusion from quality measures: Many HEDIS measures have exclusions for patients receiving palliative care; some PQA and HEDIS measures have exclusions for patients who are in or use hospice services.
Applicable lines of business
- Applies to Commercial line of business.
- Applies to Medicare line of business.

Operational note: See the Quality and Coding Tools Tip Sheets for measure-specific details and guidance on applying exclusions.

Policy Summary

PayerPremera Bluecross

PolicyHospice and Palliative Care Exclusions

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionRefer to the Quality and Coding Tools Tip Sheets to determine measure-specific exclusions for patients receiving palliative care or in hospice.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Palliative and Hospice Codes

Palliative care codesmixed

G9054	Oncology; primary focus of visit; supervising, coordinating or managing care of patient with terminal cancer; includes symptom management; end-of-life care planning, management of palliative therapies
M1017	Patient admitted to palliative care services
Z51.5	Encounter for palliative care

Hospice codesmixed

99377	Physician supervision of a hospice patient (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with health care professional(s), family member(s), surrogate decision maker(s) and/or caregiver(s) involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy
99378	Physician supervision of a hospice patient (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with health care professional(s), family member(s), surrogate decision maker(s) and/or caregiver(s) involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy
G0182	Physician supervision of a patient under a Medicare-approved hospice (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in the patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more
G9473	Services performed by chaplain in the hospice setting
G9474	Services performed by dietary counselor in the hospice setting
G9475	Services performed by other counselor in the hospice setting
G9476	Services performed by volunteer in the hospice setting
G9477	Services performed by care coordinator in the hospice setting
G9478	Services performed by other qualified therapist in the hospice setting
G9479	Services performed by qualified pharmacist in the hospice setting

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inv-04: G0182 time threshold

ThresholdWithin a calendar month, 30 minutes or more

Applies to codeG0182 (Physician supervision of a patient under a Medicare-approved hospice, patient not present)

ContextRepresents cumulative physician supervision time within the calendar month for Medicare-approved hospice patients

Quality Measure Exclusions — Provider Notes

Note

Hospice and Palliative Care Exclusions

Many Healthcare Effectiveness Data and Information Set (HEDIS) measures include exclusions for patients receiving palliative care, and some Medicare Part D Pharmacy Quality Alliance (PQA) and HEDIS measures include exclusions for patients who are in or using hospice services. Refer to the Quality and Coding Tools tip sheets for measure-specific exclusion details.

HEDIS measures commonly exclude patients receiving palliative care
Some PQA and HEDIS measures exclude patients in hospice
See Quality and Coding Tools Tip Sheets for measure-level guidance

Term Definitions

inv-06: Palliative care

DefinitionVisits focused on symptom management, end-of-life care planning, and management of palliative therapies

Representative HCPCS/CPT codesG9054 (Oncology; primary focus of visit; supervising, coordinating or managing care of patient with terminal cancer)

Representative HCR/NON-ICD codeM1017 (Patient admitted to palliative care services)

ICD-10Z51.5 (Encounter for palliative care)

inv-07: Hospice physician supervision (non-patient present)

Definition (physician supervision, patient not present)CPT 99377/99378 describe physician supervision of a hospice patient (patient not present) requiring complex, multidisciplinary care modalities involving development/revision of care plans, review of reports and studies, and communication with caregivers and health professionals

Examples of hospice supervision codes99377, 99378

Related HCPCS/service codesG0182 (physician supervision within a calendar month, 30+ minutes); G9473–G9479 (ancillary hospice services)