Summary & Overview
CPT 99377: Physician Supervision of Hospice Patient, Care Plan Oversight
CPT code 99377 represents physician supervision and care plan oversight for hospice patients, specifically when the patient is not present and the physician dedicates 15–29 minutes within a calendar month to complex, multidisciplinary care activities. This code is nationally significant as it supports the coordination and quality of hospice care, ensuring that patients with serious illnesses receive comprehensive management even outside direct encounters. The service includes tasks such as developing and revising care plans, reviewing patient status and laboratory results, and communicating with healthcare professionals, family members, or surrogate decision makers.
Major payers covering this code include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting broad national applicability across commercial insurance providers. Readers will gain insight into the clinical context of hospice care plan oversight, relevant policy updates, and billing benchmarks associated with this code. The publication also addresses common modifiers, associated provider taxonomies, and typical ICD-10 diagnoses linked to hospice care, providing a comprehensive overview for stakeholders involved in hospice billing and policy analysis.
This summary offers a clear understanding of the scope and requirements for billing CPT code 99377, highlighting its role in supporting multidisciplinary hospice care and the importance of accurate documentation and communication in the care of patients with complex needs.
CPT Code Overview
CPT code 99377 is used for physician supervision of a hospice patient when the patient is not present. This service involves complex and multidisciplinary care modalities, including regular physician development and revision of care plans, review of patient status reports, laboratory and other studies, and communication with healthcare professionals, family members, surrogate decision makers, or key caregivers. The service is provided within a calendar month and requires 15–29 minutes of physician time.
Service Type: Evaluation and Management – Care Plan Oversight (Hospice)
Typical Site of Service: Home (Place of Service 12)
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a hospice patient with advanced illness, such as metastatic lung cancer (C34.90), Alzheimer's disease (G30.9), heart failure (I50.9), or chronic obstructive pulmonary disease (J44.9). The patient is receiving palliative care at home (Place of Service 12). The physician, not physically present with the patient, spends 15–29 minutes within a calendar month supervising the patient's care. This includes developing or revising the care plan, reviewing status reports, laboratory and other studies, and communicating with healthcare professionals, family members, or caregivers to integrate new information and adjust medical therapy as needed. The workflow is multidisciplinary, requiring coordination among various providers and caregivers to ensure optimal hospice care.
Coding Specifications
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Modifiers:
Modifier Code Description When Used 25Significant, Separately Identifiable Evaluation and Management Service Used when a distinct E/M service is performed in addition to care plan oversight. 32Mandated Services Used when services are mandated by a third party, such as Blue Cross Blue Shield, Cigna Health, or Medicare. -
Provider Taxonomies:
Taxonomy Code Specialty 207Q00000XInternal Medicine 208D00000XFamily Medicine
These taxonomies represent providers who typically deliver hospice care plan oversight services.
Related Diagnoses
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Z51.5: Encounter for palliative care- Indicates the patient is receiving palliative care, which is central to hospice services.
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C34.90: Malignant neoplasm of unspecified part of unspecified bronchus or lung- Represents advanced lung cancer, a common diagnosis in hospice patients requiring complex care oversight.
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G30.9: Alzheimer's disease, unspecified- Reflects patients with advanced dementia needing multidisciplinary hospice care.
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I50.9: Heart failure, unspecified- Applies to patients with end-stage heart failure under hospice supervision.
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J44.9: Chronic obstructive pulmonary disease, unspecified- Used for patients with severe COPD receiving hospice and palliative care.
Related CPT Codes
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99375: Physician supervision of patients under care of home health agency in home, domiciliary or equivalent environment requiring complex and multidisciplinary care modalities (patient not present), 30 minutes or more.- Used for care plan oversight of home health patients, not hospice, and for longer durations (30+ minutes).
- May be used as an alternative to
99377when the patient is under home health care and the oversight time exceeds 30 minutes.
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99378: Care plan oversight service for hospice (typically per calendar month, longer time).- Used for hospice care plan oversight when the physician spends more than 29 minutes in a calendar month.
- Commonly used as an alternative to
99377for longer, more complex oversight.
National Reimbursement Benchmarks
For CPT code 99377, national mean rates among commercial payers are highest with UnitedHealth Group at $99.99, followed by Cigna at $89.37, Blue Cross Blue Shield at $80.61, and Aetna at $53.40. The BUCA composite mean rate stands at $78.99. Compared to the BUCA average, Aetna's mean rate is notably lower, while UnitedHealth Group's is substantially higher. Medicare data is not available in the input.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Aetna shows the tightest range at $22.75, indicating less variability in rates, while Cigna and UnitedHealth Group exhibit the widest ranges at $53.57 and $54.33, respectively, reflecting greater variability in reimbursement. Blue Cross Blue Shield and BUCA have moderate dispersion, with ranges of $31.75 and $38.31.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
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