M1137 Degenerative Neurological Condition HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS Level II M1137: Degenerative Neurological Condition Documentation

HCPCS Level II code M1137 denotes documentation that a patient has a degenerative neurological condition—examples include amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), or Parkinson’s disease—diagnosed at any time before or during the episode of care. Nationally, clear capture of chronic neurologic diagnoses is important for care coordination, risk stratification, and appropriate service planning across outpatient, home health, and specialty neurology settings. Key payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn what M1137 represents clinically and operationally, which payers commonly recognize the code, and what contexts the code is typically applied in clinical documentation. The publication also summarizes common billing modifiers and related administrative elements where available, outlines typical sites of service for use of the code, and highlights how the code supports documentation-driven workflows for patients with progressive neurologic disease. Data not available in the input is noted where specific fields (such as associated taxonomies, ICD-10 mappings, and payer-specific reimbursement rates) are absent.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1137HCPCS Level IIdegenerative neurological conditionsneurology documentationhome healthoutpatient careclinical documentationbilling

Billing Code Overview

HCPCS Level II code M1137 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 neurologic diagnosis in the patient record.

Service type: Documentation/diagnostic history capture related to chronic degenerative neurological conditions
Typical site of service: Outpatient clinics, neurology practices, home health settings, and other ambulatory care environments where clinical documentation is collected and recorded

Clinical & Coding Specifications

Clinical Context

A typical patient is a 58-year-old individual with progressive motor weakness, dysarthria, and gait instability who presents to a neurology clinic or home health team for longitudinal care. The clinician documents a prior diagnosis of a degenerative neurological condition such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), or Parkinson's disease made at any time before or during the episode of care. The workflow begins with a history and review of systems focused on disease course, functional status, and symptom progression, followed by focused neurologic examination and medication reconciliation. Documentation explicitly states the degenerative diagnosis to support care planning, durable medical equipment needs, referrals (e.g., physical therapy, occupational therapy, speech therapy), and eligibility for disease-specific services. Typical sites of service include outpatient neurology clinics, home health visits, long-term care facilities, and multidisciplinary specialty clinics. Common clinical tasks associated with this documentation include medication management, advance care planning notes, coordination with therapists, and orders for assistive devices or home modifications. Billing for M1137 is used when documentation confirms a degenerative neurological diagnosis such as ALS, MS, or Parkinson's disease during the episode of care.

Coding Specifications

Modifier	Description	When to Use

HCPCS M1119: Interrupted Ongoing Care Due to Hospitalization or Surgery

HCPCS-M1143-NECK-REHABILITATION-INITIATION

HCPCS M1143: Initiation of Neck Rehabilitation Episode

HCPCS-M1129-ONGOING-CARE-INTERRUPTED-BY-HOSPITALIZATION-OR-SURGERY

HCPCS M1129: Ongoing Care Interrupted by Hospitalization or Surgery

HCPCS-LEVEL-II-M1111-EPISODE-OF-CARE-INITIATION-DOCUMENTATION

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

HCPCS-M1122-DEGENERATIVE-NEUROLOGICAL-CONDITION-DOCUMENTATION

HCPCS M1122: Degenerative Neurological Condition Documentation

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

HCPCS M1132: Ongoing Care Not Clinically Indicated

HCPCS-M1106-START-OF-EPISODE-OF-CARE

HCPCS M1106: Start of Episode of Care

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

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

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

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

HCPCS-M1128-HOME-PROGRAM-REFERRAL-OR-CONSULTATION-ONLY

HCPCS M1128: Ongoing Care Not Clinically Indicated; Home Program/Referral/Consult

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Taxonomy Code	Specialty	Notes
`207RN0500X`	Neurology - Registered Nurse	Nurses specializing in neurology who coordinate chronic degenerative disease care.
`2084N0400X`	Neurology	Physicians specializing in diagnosis and management of ALS, MS, and Parkinson's disease.
`261QM0800X`	Physical Therapy	Physical therapists who provide mobility and balance interventions for degenerative neurologic conditions.
`261QS0200X`	Occupational Therapy	Occupational therapists focusing on activities of daily living, adaptive equipment, and home safety.
`261G00000X`	Speech-Language Pathology	Speech therapists who address dysphagia and communication deficits common in these diseases.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G12.21`	Amyotrophic lateral sclerosis	Primary diagnosis for patients with progressive motor neuron degeneration; documentation supports disease-specific services and equipment.
`G35`	Multiple sclerosis	Chronic demyelinating disease frequently documented to guide disease-modifying therapies and rehabilitation planning.
`G20`	Parkinson's disease	Neurodegenerative movement disorder that requires ongoing medication management and supportive services.
`R53.83`	Other fatigue	Common symptom in degenerative neurologic diseases and relevant to functional assessment and care planning.
`R47.01`	Aphasia	Communication impairment that may occur in degenerative neurologic conditions and drive speech therapy referrals.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common E/M visit used for routine neurologic follow-up and documentation of a degenerative neurologic diagnosis.
`99304`	Nursing facility initial comprehensive assessment and care plan (per day)	Used when documenting diagnosis and care needs for a patient newly admitted to a nursing facility with a degenerative neurologic condition.
`95816`	Needle electromyography, 1 extremity, with or without related paraspinal areas	Performed to support diagnosis of motor neuron disease such as ALS; often part of the diagnostic workup referenced in documentation.
`96127`	Brief emotional/behavioral assessment (e.g., depression inventory)	Used for screening common neuropsychiatric symptoms in MS, Parkinson's disease, and ALS and documented in the episode of care.
`94664`	Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device	Used in ALS patients with respiratory therapy needs and documented authorization for respiratory equipment.

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