Summary & Overview
HCPCS Level II M1107: Documentation of Degenerative Neurological Diagnosis
HCPCS Level II code M1107 documents the presence of a degenerative neurological diagnosis—such as ALS, MS, or Parkinson’s disease—recorded at any time before or during an episode of care. Nationally, standardized use of this code supports consistent clinical documentation, care coordination, and appropriate utilization tracking for patients with progressive neurologic disorders. The code is relevant across care settings where diagnosis verification informs treatment planning, durable medical equipment decisions, and care transitions.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical context, typical sites of service, and common billing modifiers and operational considerations. The publication highlights benchmarking themes and policy implications affecting documentation practices and claims processing. Practical information is provided for coders, clinicians, and revenue cycle staff on where M1107 is applied and why explicit diagnostic documentation matters for longitudinal care management. Data not available in the input is identified where applicable.
Billing Code Overview
HCPCS Level II code M1107 documents that a patient has a diagnosis of a degenerative neurological condition, such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), or Parkinson’s disease, diagnosed at any time before or during the episode of care. This code is used to record the presence of a chronic, progressive neurological disorder in the patient’s medical record.
Service Type: Clinical documentation of chronic degenerative neurological diagnosis
Typical Site of Service: Inpatient and outpatient settings where diagnosis documentation is required, including hospitals, specialty neurology clinics, and home health or hospice records when applicable.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with progressive gait instability and slurred speech is evaluated by a multidisciplinary home health team following discharge from a neurology inpatient stay. The patient has an established diagnosis of a degenerative neurological condition (for example, amyotrophic lateral sclerosis, multiple sclerosis, or Parkinson disease) documented in the chart at any time prior to or during the home health episode of care. The clinical workflow begins with a physician or qualified practitioner documenting the diagnosis in the medical record and certifying home health services. A registered nurse performs an initial home visit to confirm the diagnosis documentation, assess functional status, respiratory status, mobility, swallowing, skin integrity, and need for durable medical equipment. Physical therapy and occupational therapy evaluate mobility, transfers, activities of daily living, and home safety. Speech-language pathology evaluates dysphagia and communication if indicated. Ongoing visits include monitoring for disease progression, medication management, caregiver education, and coordination with neurology. Documentation confirming the degenerative neurologic diagnosis is included in the medical record to support the use of billing code M1107 during the episode of care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural service | Use when work required for the service is substantially greater than typically required. |