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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.

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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.

Service type: Administrative/clinical episode initiation and documentation
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

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HCPCS M1106: Start of Episode of Care

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Billing Code Overview

Service type: Administrative/clinical episode initiation and documentation
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.
`52`	Reduced services	Use when the documented episode start is partially performed or limited in scope compared to full service.
`53`	Discontinued procedure	Use when the episode-of-care initiation was begun but terminated due to patient condition or intra-service issue.
`54`	Surgical care only	Use when the billing provider documents only the intraoperative portion and another provider bills pre/post care for the episode.
`55`	Postoperative management only	Use when the billing provider documents only postoperative follow-up as part of the episode.
`56`	Preoperative management only	Use when only preoperative evaluation is furnished as the episode initiation and another provider performs the procedure.
`62`	Two surgeons	Use when two surgeons of distinct specialties jointly document the start of a complex surgical episode.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an APP documents the start of an episode as an assistant at surgery where allowed.
`QX`	CRNA service: medical direction of one CRNA by anesthesiologist	Use when the episode start involves anesthesia services with this specific supervision arrangement.

Taxonomy Code	Specialty	Notes
`207P00000X`	Physical Therapist	Commonly documents initiation of therapy episodes for musculoskeletal injuries.
`208000000X`	Family Medicine	Often initiates episodes of care for chronic disease management or acute problems.
`207L00000X`	Pain Medicine	Initiates episodes for interventional pain management or chronic pain plans.
`208000000X`	Internal Medicine	Initiates complex medical management episodes, transitions of care.
`207K00000X`	Orthopedic Surgery	Initiates surgical episodes and documents preoperative episode start.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M54.5`	Low back pain	Common reason for initiating an episode of care for physical therapy, pain management, or orthopedic evaluation.
`S81.001A`	Unspecified open wound, right knee, initial encounter	Example acute injury that prompts initiation of a wound care or orthopedic episode of care.
`M25.561`	Pain in right knee	Frequently leads to initiation of a musculoskeletal care episode including imaging and therapy.
`I10`	Essential (primary) hypertension	Chronic condition where a clinician documents the start of an ongoing management episode for blood pressure control.
`M54.2`	Cervicalgia	Common reason to start a therapy or pain management episode for neck pain.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99204`	Office or other outpatient visit for the evaluation and management of a new patient, moderate to high complexity	Can be used to document the initial comprehensive visit that establishes and documents the start of an episode of care.
`99205`	Office or other outpatient visit for the evaluation and management of a new patient, high complexity	Used when the initial episode start requires high-complexity decision making and extensive documentation.
`99024`	Postoperative follow-up visit, included in global service	May be used in the continuum after an episode start when global surgery rules apply; documentation must clarify episode components billed by each provider.
`97001`	Physical therapy evaluation	Often performed at the initiation of a therapy episode and documents baseline findings and plan.
`99291`	Critical care, evaluation and management of the critically ill or injured patient, first 30-74 minutes	Used when the episode start occurs in an acute critical care setting requiring intensive management at initiation.

HCPCS Level II M1111: Start of Episode of Care, Documentation

HCPCS-LEVEL-II-M1120-PATIENT-SELF-DISCHARGED-EARLY

HCPCS Level II M1120: Ongoing Care Not Possible Due to Patient Self-Discharge

HCPCS-M1107-DEGENERATIVE-NEUROLOGICAL-DIAGNOSIS-DOCUMENTATION

HCPCS Level II M1107: Documentation of Degenerative Neurological Diagnosis

HCPCS-M1108-HOME-PROGRAM-REFERRAL-CONSULTATION-ONLY

HCPCS M1108: Ongoing Care Not Clinically Indicated; Home Program/Referral/Consult

HCPCS-M1109-ONGOING-CARE-INTERRUPTED-DUE-TO-EARLY-DISCHARGE

HCPCS M1109: Ongoing Care Interrupted Due to Early Discharge

HCPCS-M1110-EARLY-SELF-DISCHARGE-CARE-INTERRUPTED

HCPCS M1110: Ongoing Care Interrupted by Patient Self-Discharge

HCPCS-M1112-DEGENERATIVE-NEUROLOGICAL-DIAGNOSIS-DOCUMENTATION

HCPCS Level II M1112: Documentation of Degenerative Neurological Diagnosis

HCPCS-M1113-ONGOING-CARE-NOT-CLINICALLY-INDICATED-HOME-PROGRAM-REFERRAL-CONSULTATION

HCPCS M1113: Ongoing Care Not Clinically Indicated (Home Program/Referral/Consult)

HCPCS-M1114-CARE-DISCONTINUED-DUE-TO-HOSPITALIZATION-OR-SURGERY

HCPCS M1114: Care Discontinued Due to Hospitalization or Scheduled Surgery

HCPCS-M1115-PATIENT-SELF-DISCHARGE-INTERRUPTED-CARE

HCPCS M1115: Ongoing Care Interrupted by Patient Self-Discharge

Showing 1–10 of 37

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

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.
`52`	Reduced services	Use when the documented episode start is partially performed or limited in scope compared to full service.
`53`	Discontinued procedure	Use when the episode-of-care initiation was begun but terminated due to patient condition or intra-service issue.
`54`	Surgical care only	Use when the billing provider documents only the intraoperative portion and another provider bills pre/post care for the episode.
`55`	Postoperative management only	Use when the billing provider documents only postoperative follow-up as part of the episode.
`56`	Preoperative management only	Use when only preoperative evaluation is furnished as the episode initiation and another provider performs the procedure.
`62`	Two surgeons	Use when two surgeons of distinct specialties jointly document the start of a complex surgical episode.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an APP documents the start of an episode as an assistant at surgery where allowed.
`QX`	CRNA service: medical direction of one CRNA by anesthesiologist	Use when the episode start involves anesthesia services with this specific supervision arrangement.

Taxonomy Code	Specialty	Notes
`207P00000X`	Physical Therapist	Commonly documents initiation of therapy episodes for musculoskeletal injuries.
`208000000X`	Family Medicine	Often initiates episodes of care for chronic disease management or acute problems.
`207L00000X`	Pain Medicine	Initiates episodes for interventional pain management or chronic pain plans.
`208000000X`	Internal Medicine	Initiates complex medical management episodes, transitions of care.
`207K00000X`	Orthopedic Surgery	Initiates surgical episodes and documents preoperative episode start.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M54.5`	Low back pain	Common reason for initiating an episode of care for physical therapy, pain management, or orthopedic evaluation.
`S81.001A`	Unspecified open wound, right knee, initial encounter	Example acute injury that prompts initiation of a wound care or orthopedic episode of care.
`M25.561`	Pain in right knee	Frequently leads to initiation of a musculoskeletal care episode including imaging and therapy.
`I10`	Essential (primary) hypertension	Chronic condition where a clinician documents the start of an ongoing management episode for blood pressure control.
`M54.2`	Cervicalgia	Common reason to start a therapy or pain management episode for neck pain.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99204`	Office or other outpatient visit for the evaluation and management of a new patient, moderate to high complexity	Can be used to document the initial comprehensive visit that establishes and documents the start of an episode of care.
`99205`	Office or other outpatient visit for the evaluation and management of a new patient, high complexity	Used when the initial episode start requires high-complexity decision making and extensive documentation.
`99024`	Postoperative follow-up visit, included in global service	May be used in the continuum after an episode start when global surgery rules apply; documentation must clarify episode components billed by each provider.
`97001`	Physical therapy evaluation	Often performed at the initiation of a therapy episode and documents baseline findings and plan.
`99291`	Critical care, evaluation and management of the critically ill or injured patient, first 30-74 minutes	Used when the episode start occurs in an acute critical care setting requiring intensive management at initiation.

HCPCS Level II M1111: Start of Episode of Care, Documentation

HCPCS-LEVEL-II-M1120-PATIENT-SELF-DISCHARGED-EARLY

HCPCS Level II M1120: Ongoing Care Not Possible Due to Patient Self-Discharge

HCPCS-M1107-DEGENERATIVE-NEUROLOGICAL-DIAGNOSIS-DOCUMENTATION

HCPCS Level II M1107: Documentation of Degenerative Neurological Diagnosis

HCPCS-M1108-HOME-PROGRAM-REFERRAL-CONSULTATION-ONLY

HCPCS M1108: Ongoing Care Not Clinically Indicated; Home Program/Referral/Consult

HCPCS-M1109-ONGOING-CARE-INTERRUPTED-DUE-TO-EARLY-DISCHARGE

HCPCS M1109: Ongoing Care Interrupted Due to Early Discharge

HCPCS-M1110-EARLY-SELF-DISCHARGE-CARE-INTERRUPTED

HCPCS M1110: Ongoing Care Interrupted by Patient Self-Discharge

HCPCS-M1112-DEGENERATIVE-NEUROLOGICAL-DIAGNOSIS-DOCUMENTATION

HCPCS Level II M1112: Documentation of Degenerative Neurological Diagnosis

HCPCS-M1113-ONGOING-CARE-NOT-CLINICALLY-INDICATED-HOME-PROGRAM-REFERRAL-CONSULTATION

HCPCS M1113: Ongoing Care Not Clinically Indicated (Home Program/Referral/Consult)

HCPCS-M1114-CARE-DISCONTINUED-DUE-TO-HOSPITALIZATION-OR-SURGERY

HCPCS M1114: Care Discontinued Due to Hospitalization or Scheduled Surgery

HCPCS-M1115-PATIENT-SELF-DISCHARGE-INTERRUPTED-CARE

HCPCS M1115: Ongoing Care Interrupted by Patient Self-Discharge

Showing 1–10 of 37

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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HCPCS M1106: Start of Episode of Care

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Billing Code Overview

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HCPCS M1106: Start of Episode of Care

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

HCPCS M1106: Start of Episode of Care

Sign up for hcpcs M1106 policy alerts

Billing Code Overview

HCPCS M1106: Start of Episode of Care

Sign up for hcpcs M1106 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does HCPCS M1106 represent and where is it typically used?

Which modifiers are listed for use with M1106 and when would they apply?

How does M1106 relate to the listed CPT codes such as 99204, 97001, and 99291?

Which payers are mentioned as covering or relevant for M1106, and does this page provide payer-specific rules?

What clinical situations and workflow elements typically justify use of M1106?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does HCPCS M1106 represent and where is it typically used?

Which modifiers are listed for use with M1106 and when would they apply?

How does M1106 relate to the listed CPT codes such as 99204, 97001, and 99291?

Which payers are mentioned as covering or relevant for M1106, and does this page provide payer-specific rules?

What clinical situations and workflow elements typically justify use of M1106?

References