M1060 HCPCS Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS M1060: Patient Died Prior to End of Performance Period

HCPCS Level II code M1060 documents that a patient died prior to the end of a defined performance period. As an administrative and outcome code, it is used to close or adjust service episodes when mortality prevents completion of planned care. Nationally, accurate use of M1060 affects quality reporting, performance measure calculations, capitated payments, and claims adjudication tied to episode-based contracts. It also supports accurate mortality tracking in program evaluations and payer reconciliation.

Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical and administrative role, guidance on typical sites of service where it is applied, common modifiers associated with the code, and notes on where input data were not provided. The publication outlines how M1060 intersects with performance-period reporting and claims workflows, and summarizes implications for benchmarking, reporting accuracy, and payer reconciliation. Data not available in the input are identified clearly where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1060HCPCS Level IImortalityperformance periodclaims administrationepisode-based reportingquality reportinghospiceinpatient

Billing Code Overview

HCPCS Level II code M1060 indicates that the patient died prior to the end of the performance period. This code documents an event where scheduled or ongoing services were not completed because the patient expired before the performance period concluded.

Service type: End-of-life outcome documentation and administrative closure of an active care episode
Typical site of service: Inpatient facility, hospice, or other care settings where a defined performance period was in effect

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves a hospice or home health patient who is enrolled in a time-limited performance period for a service or outcome measure and who dies before the end of that period. For example, a 78-year-old patient with advanced metastatic lung cancer is admitted to a home-based palliative care program with a 30-day performance interval for symptom management and care coordination. The patient receives initial assessments, medications adjustments, and interdisciplinary visits. During the second week of the performance period the patient experiences progressive respiratory failure and dies at home. The clinical workflow includes documentation of the death, termination of ongoing performance activities, notification of the payer and responsible providers, completion of final nursing and physician notes, updating the electronic health record and claims status, and submission of the appropriate HCPCS level II code M1060 to indicate that the patient died prior to the end of the performance period.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Rarely applicable; use when significant additional work was required before death (documented) related to the performance period tasks.

HCPCS M1053: Leg Pain VAS Preoperative and One-Year Postoperative Assessment

HCPCS-M1066-SHINGRIX-VACCINE-NOT-DOCUMENTED-ADMINISTERED

HCPCS M1066: Shingrix Vaccine Not Documented as Administered

HCPCS-M1068-NON-AMBULATORY-ADULT-CARE

HCPCS Level II M1068: Adults Who Are Not Ambulatory

HCPCS-M1026-HOSPICE-STATUS-ANY-TIME-DURING-PERFORMANCE-PERIOD

HCPCS M1026: Patients in Hospice During Performance Period

HCPCS-M1050-OSWESTRY-DISABILITY-INDEX-FUNCTIONAL-STATUS

HCPCS Level II M1050: Oswestry Disability Index Functional Status Measurement

HCPCS-M1025-HOSPICE-ENROLLMENT-DURING-PERFORMANCE-PERIOD

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

HCPCS-M1062-PATIENT-IMMUNOCOMPROMISED

HCPCS M1062: Patient Immunocompromised

HCPCS-M1035-PHASED-OUT-MAT-BEFORE-180-DAYS-CONTINUOUS-TREATMENT

HCPCS Level II M1035: Adults Phased Out of MAT Before 180 Days

HCPCS-M1014-DISCHARGE-EPISODE-OF-CARE-DOCUMENTATION

HCPCS M1014: Discharge/Discontinuation of Episode of Care

HCPCS-M1024-ADOLESCENT-DEPRESSION-NONREMISSION-6-MONTHS

HCPCS M1024: Adolescent Depression Nonremission at Six Months

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Taxonomy Code	Specialty	Notes
`207Q00000X`	Hospice and Palliative Medicine	Primary specialty managing end-of-life care and performance-period activities.
`251B00000X`	Home Health Agency	Organizations and clinicians providing home-based skilled services and coordination.
`208V00000X`	Internal Medicine	Hospitalists and primary care physicians often involved in care transitions and end-of-life management.
`207L00000X`	Pain Medicine	Specialists consulted for complex symptom control prior to death.
`207K00000X`	Geriatric Medicine	Clinicians managing frail, elderly patients in performance-period programs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z66`	Do not resuscitate (DNR) status	Relevant to end-of-life planning and may be documented during the performance period prior to death.
`Z51.5`	Encounter for palliative care	Commonly associated with patients enrolled in performance periods for symptom management who may die before completion.
`C34.90`	Malignant neoplasm of unspecified part of unspecified bronchus or lung, unspecified	Represents advanced lung cancer, a common terminal diagnosis in hospice or palliative performance periods.
`I50.9`	Heart failure, unspecified	Advanced heart failure is a frequent terminal condition in which patients may die during a performance interval.
`J96.00`	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	Acute deterioration that can lead to death during an active performance period.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99221`	Initial hospital care, typically 30 minutes	Initial hospital evaluation that may precede enrollment in a performance period; documentation may be present before death.
`99304`	Initial nursing facility care, per day, for the evaluation and management of a patient	Used for initial facility-based assessments when the performance period includes nursing facility care prior to the patient dying.
`99497`	Advance care planning including explanation and discussion of advance directives	Often performed during the performance period; relevant to documentation of goals of care before death.
`99499`	Unlisted evaluation and management service	Used when no specific CPT matches a unique evaluation or coordination activity completed prior to death.
`99341`	Home visit for the evaluation and management of a new patient	Home-based visits that commonly occur during a performance period and may be ended prematurely by patient death.

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