Summary & Overview
HCPCS Level II M1059: Hospice or Palliative Care Status
HCPCS Level II code M1059 captures when a patient was in hospice or receiving palliative care at any time during the performance period. As a status-designation code, it matters nationally for accurate clinical documentation, quality reporting, and care coordination across settings that serve seriously ill patients. Proper use of the code supports clear records of hospice or palliative involvement, which can affect care planning and downstream billing or quality measurement processes.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical intent, typical sites of service (hospice facilities and home-based palliative care), and the practical role the code plays in administrative records. The publication outlines common billing considerations, lists applicable modifiers provided in the input, and summarizes where additional data is not available in the source material.
This content is written for a national audience and is intended to inform clinicians, coders, and policy staff about the meaning and administrative context of M1059. Data not available in the input is noted where relevant.
Billing Code Overview
HCPCS Level II code M1059 indicates that the patient was in hospice or receiving palliative care at any time during the performance period. This code documents patient status related to end-of-life or comfort-focused care rather than a specific clinical procedure.
Service Type: Palliative care / Hospice status documentation
Typical Site of Service: Hospice facility, home hospice, or any care setting where palliative services are provided
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A common scenario involves an adult patient with a terminal illness (for example, metastatic lung cancer or advanced heart failure) who is formally enrolled in a hospice program or receiving active palliative care services during the measurement or performance period. The patient may be managed at home, in an inpatient hospice unit, a skilled nursing facility, or an acute care hospital that provides palliative consults. Clinical workflow: upon admission to hospice or initiation of palliative care, the hospice or palliative care clinician documents enrollment/active status in the medical record and notifies the billing department. Encounter documentation includes hospice/palliative care plan, advance care planning notes, symptom management (e.g., pain, dyspnea), and interdisciplinary team notes. Coding staff apply billing indicator M1059 to denote that the patient was in hospice or receiving palliative care at any time during the performance period for quality reporting or measure attribution. Common coordination occurs between hospice clinicians, primary care, oncologists, and facility staff to document dates of hospice/palliative enrollment and any changes in level of care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when unusually extensive work beyond typical hospice-related visit or procedure occurs and documentation supports increased complexity. |