Hospice care now represents the standard of care for many patients in the last months of life. Not just for patients with cancer or progressive neurologic diseases, hospice care is increasingly common for patients with end-stage cardiac, renal, liver, and pulmonary diseases. For specialist physicians in pulmonology, cardiology, and critical care, the practical issues about coding and billing for specialist services for hospice-enrolled patients may be problematic. This article briefly reviews hospice care and the potential barriers to appropriate and timely referral. Coding for specialist services related to hospice care is reviewed, as well as delineation of how and when reimbursement is better carried out through the Medicare hospice benefit, rather than through the usual reimbursement mechanisms.