M1067 Hospice Services HCPCS: Reimbursement | OpenPayer

Summary & Overview

HCPCS Level II M1067: Hospice Services During Measurement Period

HCPCS Level II code M1067 denotes hospice services provided to a patient at any time during the measurement period. This indicator is important for national reporting, quality measurement, and care coordination because hospice involvement affects care goals, utilization patterns, and end-of-life quality metrics. The code is used across payers to document whether hospice services were rendered during a defined measurement window, informing population-level assessments and reporting requirements.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what M1067 represents, how it is used in clinical and administrative contexts, and which payers commonly include it in measurement and reporting workflows. The publication summarizes benchmark considerations, implications for care coordination and quality measurement, and relevant policy or coding context where available.

Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1067HCPCS Level IIhospicequality-measurementend-of-life-careservice-linebillinghealthcare-coding

Billing Code Overview

HCPCS Level II code M1067 represents hospice services provided to a patient at any time during the measurement period. This code indicates the provision of hospice care services and is used to capture whether a patient received hospice services within the reporting timeframe.

Service type: Hospice services
Typical site of service: Hospice settings or patient residence where hospice care is delivered (including home hospice and inpatient hospice facilities)

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with a terminal, life-limiting illness (for example, advanced metastatic cancer, end-stage heart failure, or progressive neurodegenerative disease) who elects hospice care during the measurement period. The most common workflow begins with the treating physician documenting a prognosis of six months or less if the disease runs its normal course and certifying hospice eligibility. The patient and/or surrogate signs hospice election forms and selects a hospice provider. Hospice services can include interdisciplinary visits by physicians, nurses, social workers, chaplains, home health aides, medication and durable medical equipment related to the terminal diagnosis, and 24/7 on-call support. Billing for hospice services using M1067 occurs for any time hospice services are provided during the measurement period and may be submitted by the hospice agency for the global hospice benefit. Clinical documentation typically includes the hospice election statement, physician certification(s), plan of care, interdisciplinary team notes, medication lists, and encounter records showing dates of service during the measurement period.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the hospice provider documents work or intensity substantially greater than typically required for hospice administrative or procedural tasks when applicable for billable physician services associated with hospice certification or consults.

HCPCS Level II M1070: Patient Not Screened for Future Fall Risk

HCPCS-M1055-ASPIRIN-ANTIPLATELET-THERAPY-USED

HCPCS Level II M1055: Aspirin or Other Antiplatelet Therapy Used

HCPCS-M1041-LUMBAR-SPINE-PATHOLOGY-SCOLIOSIS-FRACTURE-INFECTION

HCPCS M1041: Lumbar Spine Disease and Scoliosis Management

HCPCS-M1064-SHINGRIX-VACCINE-ADMINISTRATION-OR-DOCUMENTED-PRIOR-DOSE

HCPCS Level II M1064: Shingrix vaccine administered or previously received

HCPCS-M1062-PATIENT-IMMUNOCOMPROMISED

HCPCS M1062: Patient Immunocompromised

HCPCS-M1028-HEADACHE-IMAGING-OTHER-THAN-CT-MRI-DOCUMENTATION

HCPCS M1028: Headache Imaging Other Than CT or MRI Documentation

HCPCS-M1063-HIGH-DOSE-IMMUNOSUPPRESSIVE-THERAPY

HCPCS Level II M1063: High-Dose Immunosuppressive Therapy

HCPCS-M1033-PHARMACOTHERAPY-INITIATION-OPIOID-USE-DISORDER

HCPCS Level II M1033: Pharmacotherapy Initiation for Opioid Use Disorder

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

HCPCS Level II M1050: Oswestry Disability Index Functional Status Measurement

HCPCS-M1061-PATIENT-PREGNANCY-ASSESSMENT-DOCUMENTATION

HCPCS Level II M1061: Patient Pregnancy

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Taxonomy Code	Specialty	Notes
`185H00000X`	Hospice and Palliative Medicine Physician	Physicians who certify and manage hospice care plans and prognostication.
`251B00000X`	Registered Nurse	Nurses who provide hospice nursing visits, symptom management, and documentation.
`251S00000X`	Social Worker	Social workers who provide psychosocial assessment, family counseling, and care coordination.
`251E00000X`	Chaplain/Spiritual Counselor	Spiritual care providers who document spiritual assessments and bereavement support.
`374E00000X`	Home Health Aide	Direct care staff providing personal care and ADL assistance under hospice plans.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R99`	Ill-defined and unknown cause of mortality	May appear when hospice care is provided for end-of-life symptoms without a single definitive terminal diagnosis.
`Z51.5`	Encounter for palliative care	Directly relevant for patients receiving hospice and palliative services during the measurement period.
`C80.1`	Malignant neoplasm, unspecified, with metastasis	Common terminal oncologic diagnosis leading to hospice enrollment.
`I50.84`	End stage heart failure	Terminal cardiac diagnosis commonly associated with hospice referral.
`G30.9`	Alzheimer's disease, unspecified	Advanced neurodegenerative disease frequently managed in hospice programs.
`J84.126`	Idiopathic pulmonary fibrosis with respiratory failure	Progressive pulmonary disease that often results in hospice care for symptom management.
`N18.6`	End stage renal disease	Advanced renal disease where patients may elect hospice for comfort-focused care.
`F03.90`	Unspecified dementia without behavioral disturbance	Cognitive decline contributing to goals-of-care decisions and hospice eligibility.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99377`	Physician certification of terminal illness (add-on)	Used for formal physician certification and recertification documentation of terminal prognosis required for hospice election.
`99378`	Physician recertification of terminal illness (add-on)	Used for periodic recertification visits documenting continued hospice eligibility.
`99401`	Preventive medicine counseling (15 minutes)	Occasionally used for advance care planning or goals-of-care discussions documented alongside hospice enrollment.
`G0180`	Hospice visit, physician service in the home, per day (Medicare G-code)	Used by physicians to bill for face-to-face hospice visits in the home setting when required for certification or symptom management.
`G0181`	Physician-certified hospice visit, per day (Medicare G-code)	Used for subsequent face-to-face encounters related to hospice certification, teaching, or care coordination.

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