Summary & Overview
HCPCS M1106: Start of Episode of Care
HCPCS Level II code M1106 denotes documentation that an episode of care has been started and recorded in the medical record. Nationally, clear documentation of episode initiation supports care coordination, transitions, and compliance with episode-based payment models and quality reporting. The code is relevant across facility and clinic settings where episodes are formally opened and tracked.
Key payer coverage discussed includes Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical purpose, typical settings of use, and operational context relevant to episode-based care. The publication outlines common modifiers associated with M1106 (for reference), describes where this code typically appears on service lines, and summarizes the implications for billing workflows and medical record documentation practices.
This summary is intended for national audiences — clinicians, coding professionals, and revenue integrity teams — seeking concise guidance on what M1106 represents, how it is used in practice, and where to look for additional policy and billing considerations. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code M1106 documents the start of an episode of care as recorded in the medical record. This code indicates that a clinician or care team has formally initiated an episode-based treatment plan or care period for a patient.
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Service type: Administrative/clinical episode initiation and documentation
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Typical site of service: Facility- or clinic-based settings where episodes of care are established and recorded, such as hospitals, outpatient clinics, or specialty care centers
Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient clinic or ambulatory surgical center for initiation of a documented episode of care where the clinician records the formal start of ongoing management for a specific condition. Typical scenarios include the first comprehensive visit when a treatment plan is begun (for example, initiation of a wound care regimen, start of physical therapy after an acute injury, or the first documented visit in a multi-visit specialty episode). The workflow commonly includes intake and history review, focused physical examination, documentation that the episode of care is being started, establishment of goals and plan, any baseline measurements or images, and scheduling of follow-up visits. The service is typically provided in ambulatory clinics, outpatient specialty offices, or ambulatory surgical centers where episodic care is tracked for authorization, care management, or bundled payment purposes.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for starting an episode due to complexity or extended documentation. |
23 | Unusual anesthesia | Use when anesthesia is medically necessary and is unusual for the procedure associated with the episode start. |