Summary & Overview
HCPCS Level II M1058: Permanent Nursing Home Resident
HCPCS Level II code M1058 denotes that a patient was a permanent nursing home resident at any time during the performance period. This residency indicator is used in claims and quality reporting to flag patients receiving long-term institutional care, and it affects case-mix classification, service planning, and certain payment adjustments at a national level. The code matters because accurate residency status supports appropriate service attribution and informs payer-specific workflows for long-term care populations.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical and administrative context, typical sites of service, and the implications for billing and reporting workflows. The publication summarizes common modifiers, where available, and highlights what is known and what is not provided in the input.
This report is intended for national audiences working in billing, compliance, and care management. It provides benchmarks and policy-relevant context when available, clarifies documentation expectations tied to residency status, and outlines how M1058 integrates into service lines for long-term care populations. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code M1058 indicates that the patient was a permanent nursing home resident at any time during the performance period. This designation is used to identify patients who reside in long-term care facilities on a continuing basis.
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Service Type: Residence status / Long-term care residency indicator
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Typical Site of Service: Nursing home or other long-term care facility
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an elderly long-term resident of a skilled nursing facility who requires periodic visits from an attending physician or advanced practice clinician during the performance period. The resident may have multiple chronic conditions (for example, congestive heart failure, chronic obstructive pulmonary disease, dementia, or advanced diabetes) and receives on-site evaluation for acute changes in status, medication management, wound checks, or advance care planning. The clinical workflow begins with nursing staff identifying a clinical need, placing a visit request, and providing recent vitals and medication lists. A clinician performs an in-person or telehealth-enhanced visit at the nursing home, documents the resident’s status, updates problem lists and orders, and communicates care plan changes to facility staff. Billing uses HCPCS Level II code M1058 to indicate the patient was a permanent nursing home resident at any time during the performance period; this code is reported in conjunction with the professional service CPT codes for the specific visit or procedure provided during that encounter.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typically required and supporting documentation explains increased effort related to the professional service provided during the nursing home visit. |