HCPCS Level II M1025: Patients Enrolled in Hospice During Performance Period

HCPCS Level II code M1025 denotes patients who were enrolled in hospice at any point during the performance period. This administrative indicator is important for quality measurement, reporting, and care coordination because hospice enrollment affects eligibility for certain services, clinical expectations, and performance metrics used by payers and reporting programs. Nationally, consistent capture of hospice status supports accurate quality measurement and can influence care planning and allowable service reporting.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical context, how hospice status is reflected across service settings, and implications for measurement and documentation. The publication covers benchmark-oriented reporting considerations, common modifier usage (listed separately), and where this code typically appears in claims and performance reporting workflows. Where specific payer policies or coverage rules apply, readers will learn how hospice status interacts with billing and quality programs at a national level.

Data not available in the input for associated taxonomies, ICD-10 codes, and related service-line details.

Billing Code Overview

HCPCS Level II code M1025 indicates patients who were in hospice at any time during the performance period. This code is used to denote hospice status for a patient during the reporting or measurement window.

Service type: Hospice status indicator / patient disposition reporting
Typical site of service: Hospice care settings or any care setting where hospice enrollment is documented (for example, home hospice, inpatient hospice units, or other clinical environments where patient records reflect hospice enrollment)

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Clinical Context

A typical patient is an adult with a life-limiting illness (for example, advanced metastatic cancer, end-stage heart failure, or end-stage chronic obstructive pulmonary disease) who was enrolled in hospice care at some point during the measurement/performance period. The clinical workflow begins with hospice admission documentation that includes prognosis, advance care planning, and a plan of care. During the performance period, clinicians across settings (home hospice, inpatient hospice unit, skilled nursing facility, or hospital) document the patient’s hospice enrollment dates in the medical record and claim submissions. The hospice status is used for quality measurement, care coordination, and appropriate billing; audits rely on clear documentation showing hospice election or discharge dates, attending physician notes, and hospice agency records.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when one-time additional work beyond the typical service is documented and justifies higher payment, rarely applicable but possible for extensive end-of-life counseling tied to a billable service.
`23`	Unusual anesthesia	Use when general anesthesia is medically necessary but not normally required for the procedure provided alongside hospice-related services.

Taxonomy Code	Specialty	Notes
207P00000X	Hospice and Palliative Medicine	Primary specialty managing hospice care, documents hospice enrollment and goals of care.
208D00000X	Family Medicine	Common attending or admitting clinicians coordinating care for hospice patients across settings.
207L00000X	Medical Oncology	Frequently involved for patients with advanced cancer transitioning to hospice.
207RC0000X	Internal Medicine	Hospitalists and primary internists often document hospice status during hospital stays.
261QM0800X	Physician Assistant	Advanced practice clinicians who frequently provide hands-on care and documentation in hospice settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z51.5`	Encounter for palliative care	Common code to indicate palliative or hospice-focused care encounters and to document supportive services during hospice enrollment.
`C80.1`	Malignant (primary) neoplasm, unspecified, with metastasis	Represents advanced cancer often associated with hospice referral and enrollment.
`I50.9`	Heart failure, unspecified	End-stage heart failure is a frequent hospice diagnosis when patients elect comfort-focused care.
`J44.9`	Chronic obstructive pulmonary disease, unspecified	Advanced COPD with refractory symptoms is commonly associated with hospice enrollment.
`E87.6`	Hypokalemia	Example of an acute metabolic disturbance that may occur in hospice patients and influence care decisions; included as a commonly encountered condition in this population.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99221`	Initial hospital care, typically 30 minutes	Often used for initial inpatient evaluations where hospice status is documented when a patient is hospitalized during hospice enrollment.
`99223`	Initial hospital care, typically 70 minutes	Used for more complex initial inpatient evaluations documenting hospice enrollment and care planning.
`99341`	Home visit for established patient, low complexity	Used for home hospice visits where clinicians bill for evaluation and management of hospice patients at home.
`99497`	Advance care planning including the explanation and discussion of advance directives, first 30 minutes	Frequently performed with hospice patients to document goals of care and advance directives; supports hospice status documentation.
`G0180`	Physician certification and recertification for hospice care, routine home care (Medicare)	Relevant to documentation and billing processes that establish and confirm hospice enrollment during the performance period.

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Summary & Overview