Summary & Overview
HCPCS Level II M1015: Discharge/Discontinuation of Episode of Care
HCPCS Level II code M1015 marks the documented discharge or discontinuation of an episode of care in the medical record. Nationally, accurate reporting of discharge events underpins care coordination, quality measurement, and claims adjudication by clarifying when a defined episode has concluded and any associated services cease. The code is relevant across acute, post-acute, outpatient, and home-based care settings where episodes are managed and closed.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find guidance on the clinical context in which M1015 is used, common billing and service-line implications, and the typical sites of service where the code applies. The publication outlines benchmarks and policy considerations related to discharge documentation and coding accuracy, highlights implications for claims processing and care transitions, and identifies areas where payers commonly focus review or require supporting documentation.
This national-level summary is designed for coding professionals, billing teams, and policy analysts seeking a concise reference on the purpose and administrative significance of M1015 for episode closure documentation.
Billing Code Overview
HCPCS Level II code M1015 documents the discharge or discontinuation of an episode of care as recorded in the medical record. This code represents the formal end of a course of treatment or case management when the clinician or care team documents that the episode of care has been concluded.
Service Type: Care episode discharge / discontinuation services
Typical Site of Service: Inpatient or outpatient clinical settings where episodes of care are opened and closed in the medical record, including hospitals, skilled nursing facilities, outpatient clinics, and home health settings.
Clinical & Coding Specifications
Clinical Context
A patient who has completed an episode of skilled home health nursing, physical therapy, or other home-based services requires formal documentation of discharge from the episode of care. Typical patients are elderly or medically complex individuals receiving home health for wound care, post-operative recovery, medication management, or functional decline. The clinical workflow begins with the clinician (registered nurse, physical therapist, or home health agency clinician) performing a final visit to assess status, document outcomes, reconcile medications, complete patient and caregiver education, and confirm any needed follow-up or transition of care (for example to primary care, outpatient therapy, or hospice). The clinician documents the date and reason for discharge, summarizes the patient’s functional status and clinical progress, lists unresolved problems and pending orders, and records referrals or subsequent appointments. The agency coder or billing staff then links the discharge documentation to billing code M1015 to report discharge/discontinuation of the episode of care as documented in the medical record. Typical sites of service include the patient’s home or a domiciliary setting providing home health services. Common scenarios include: a patient achieving therapy goals and discharged to community care, a patient who transfers to an inpatient facility, or a patient who elects to stop services and is formally discharged.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |