Summary & Overview
HCPCS Level II M1022: Patients Enrolled in Hospice During Performance Period
HCPCS Level II code M1022 identifies patients who were enrolled in hospice at any point during a performance or measurement period. The designation is important for quality measurement, care coordination, and accurate reporting of end-of-life care populations. Nationally, hospice enrollment influences performance metrics, care planning, and eligibility assessments across payer lines. Key payers relevant to this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, applicability across care settings, and its role in reporting and performance measurement. The publication covers common payer coverage considerations, relevant service settings, and typical use cases for claims and quality reporting. It also outlines where this code fits within hospice-related documentation and reporting workflows. Data limitations in the input are noted as "Data not available in the input." The focus is on national applicability rather than state-specific rules or provider recommendations.
Billing Code Overview
HCPCS Level II code M1022 denotes patients who were in hospice at any time during the performance period. This code is used to identify the patient population with hospice enrollment during the reporting or measurement interval.
Service Type: Palliative and Supportive Care / Hospice-Related Reporting
Typical Site of Service: Hospice settings, inpatient hospice units, home hospice, and other sites where hospice services are provided.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult Medicare beneficiary who received hospice care during the performance period and whose hospice status must be documented for quality reporting and billing. For example, an 82-year-old patient with metastatic lung cancer transitioned to hospice services three weeks before the start of the measurement window. During the performance period a primary care clinician or hospice interdisciplinary team documents hospice enrollment in the medical record, records relevant diagnoses, and communicates goals of care. Clinical workflow includes verifying hospice admission dates in the electronic medical record, confirming current hospice status with the hospice provider, documenting hospice start and (if applicable) end dates, and including this information in the encounter note and problem list to support reporting of billing code M1022. Administrative staff reconcile hospice eligibility for payer coordination and quality measure submission.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Rarely applicable; may be used when additional documentation supports substantially greater work for related services during the same encounter |
23 |