M1117 HCPCS: Reimbursement & Benchmarks | OpenPayer

Summary & Overview

HCPCS M1117: Documentation of Degenerative Neurological Diagnosis

HCPCS Level II code M1117 designates documentation that a patient has a degenerative neurological condition such as ALS, MS, or Parkinson’s disease, identified at any time before or during an episode of care. The code is used to record the presence of a chronic neurodegenerative diagnosis that can influence clinical decision-making, equipment needs, care coordination, and eligibility for certain services. Nationally, clear documentation of such diagnoses matters for clinical continuity, appropriate service delivery, and administrative reporting.

This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, the clinical context in which it is applied, and the typical sites of service where it appears. The publication includes benchmarking information and policy context relevant to billing and documentation practices, as well as guidance on where to find related coding and clinical resources. Data limitations where input fields were not provided are noted as "Data not available in the input." The goal is to give clinicians, coders, and administrators a clear, national-level summary of HCPCS Level II code M1117 and its practical significance in care delivery.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1117HCPCS Level IIneurologydegenerative neurological conditionsALSMSParkinson's diseaseclinical documentationoutpatient

Billing Code Overview

HCPCS Level II code M1117 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. The code captures the presence of a chronic, progressive neurologic diagnosis that may affect care planning, durable medical equipment needs, and care coordination.

Service type: Diagnostic documentation / clinical status coding

Typical site of service: Outpatient clinics, neurology practices, home health settings, and other ambulatory care environments

Data not available in the input for associated taxonomies, ICD-10 diagnoses, or related codes.

Clinical & Coding Specifications

Clinical Context

A patient with a known degenerative neurological disorder—such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), or Parkinson disease—presents for a home health or outpatient care episode where documentation of the chronic diagnosis is required for care planning, durable medical equipment justification, or coordination of services. Typical workflow: the clinician (neurologist, home health physician, or advanced practice provider) reviews prior records, confirms the historical or current diagnosis, documents disease subtype and date of diagnosis, records relevant functional limitations (gait instability, dysphagia, respiratory compromise, spasticity), and links the diagnosis to current care needs. This documentation is used to support service eligibility, care planning, and billing for services associated with a degenerative neurological condition. The setting is commonly home health, outpatient neurology clinic, or inpatient consultation for care transition planning.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when services require substantially greater effort than typical due to neurologic complexity or extensive documentation related to degenerative neuro disease
`23`

Related Codes

HCPCS-M1136-START-OF-EPISODE-OF-CARE

HCPCS M1136: Start of Episode of Care, Documented in Medical Record

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

HCPCS M1114: Care Discontinued Due to Hospitalization or Scheduled Surgery

HCPCS-M1132-ONGOING-CARE-NOT-CLINICALLY-INDICATED-HOME-PROGRAM-OR-REFERRAL

HCPCS M1132: Ongoing Care Not Clinically Indicated

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

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

HCPCS-M1122-DEGENERATIVE-NEUROLOGICAL-CONDITION-DOCUMENTATION

HCPCS M1122: Degenerative Neurological Condition Documentation

HCPCS-M1119-INTERRUPTED-ONGOING-CARE-DUE-TO-HOSPITALIZATION

HCPCS M1119: Interrupted Ongoing Care Due to Hospitalization or Surgery

HCPCS-M1125-PATIENT-SELF-DISCHARGE-ONGOING-CARE-NOT-POSSIBLE

HCPCS M1125: Ongoing Care Not Possible Due to Patient Self-Discharge

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

HCPCS M1115: Ongoing Care Interrupted by Patient Self-Discharge

HCPCS-M1141-FUNCTIONAL-STATUS-NOT-MEASURED-OKS-KOOS-JR-1-YEAR

HCPCS M1141: Functional Status Not Measured by OKS or KOOS, JR. at 1 Year

HCPCS-M1126-EPISODE-START-DOCUMENTATION

HCPCS M1126: Start of Episode of Care, Documented in Record

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Taxonomy Code	Specialty	Notes
`207RG0100X`	Physical Medicine & Rehabilitation	Manages functional impairments from ALS, MS, Parkinson disease and coordinates therapy
`207RH0000X`	Neurology	Primary specialty for diagnosing and documenting degenerative neurologic conditions
`363L00000X`	Home Health Care Provider	Provides home health services where documentation of chronic neurologic diagnosis is commonly required
`208D00000X`	Internal Medicine	Often performs longitudinal documentation and coordination of care for chronic neurologic patients
`208T00000X`	Family Medicine	Provides community-based documentation and ongoing management for patients with neurodegenerative disorders

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G12.21`	Amyotrophic lateral sclerosis	Primary diagnosis for patients with progressive motor neuron degeneration requiring documentation for care planning and services
`G35`	Multiple sclerosis	Chronic demyelinating disease frequently documented to justify neurologic-directed services and supportive therapies
`G20`	Parkinson disease	Degenerative movement disorder requiring documentation to support therapy, medication management, and supportive services
`R26.89`	Other abnormalities of gait and mobility	Common functional manifestation of degenerative neurologic conditions relevant to therapy planning
`R06.02`	Shortness of breath	Symptom related to respiratory muscle involvement in advanced neuromuscular disease, relevant to treatment and monitoring
`N31.9`	Neuromuscular dysfunction of bladder, unspecified	Neurogenic bladder commonly occurs with spinal or neurodegenerative disorders and impacts management decisions
`M62.81`	Muscle weakness (generalized)	Functional symptom often documented in degenerative neurologic conditions to justify therapy and assistive devices

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99241`	Office consultation for a new or established patient, typically 15 minutes	Used when a neurologist documents diagnosis and provides consultative recommendations during a clinic visit
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Commonly used for ongoing outpatient management visits where documentation of the degenerative diagnosis is updated and care planned
`94640`	Pressurized or non-pressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes	Performed when respiratory compromise from neuromuscular weakness requires treatment or assessment
`51702`	Insertion of indwelling bladder catheter (e.g., for neurogenic bladder)	Used when lower urinary tract management is required secondary to neurologic disease
`94620`	Incentive spirometry, etc.	Performed as part of respiratory therapy and monitoring for patients with progressive neuromuscular weakness
`97110`	Therapeutic exercises to develop strength and endurance, range of motion, and flexibility	Performed by physical therapy to address functional declines related to ALS, MS, or Parkinson disease