HCPCS M1154: Hospice Services During Measurement Period - OpenPayer

Summary & Overview

HCPCS M1154: Hospice Services During Measurement Period

HCPCS Level II code M1154 designates hospice services provided to a patient at any point during the measurement period. This code captures whether a patient received hospice care and is used in quality measurement and reporting contexts to identify hospice utilization. Nationally, tracking hospice service provision is important for evaluating end-of-life care access, care coordination, and quality metrics tied to value-based programs.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on what the code represents, how it maps to hospice service delivery settings, and the relevance for quality measurement and claims-based reporting. The publication outlines typical use cases for M1154, common billing considerations, and benchmarking context where available.

The report provides an overview of benchmarks, policy implications, and clinical context relevant to hospice measurement. Where payer-specific coverage details or associated taxonomies and ICD-10 mappings are required, the reader will be signposted to payer policies and clinical documentation standards. Data not provided in the input will be noted accordingly.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1154HCPCS Level IIhospiceend-of-life carequality measurementclaims reportingpalliative carehospice services

Billing Code Overview

HCPCS Level II code M1154 describes hospice services provided to a patient any time during the measurement period. The service type is hospice care, which encompasses palliative and supportive services focused on comfort, symptom management, and end-of-life care. The typical site of service is hospice setting or the patient’s residence, including inpatient hospice facilities, hospice inpatient units, and home-based hospice care.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient enters hospice care when curative treatment is no longer the goal and focus shifts to comfort and symptom management. For example, an 82-year-old patient with advanced metastatic lung cancer and progressive functional decline is referred to hospice by the treating oncologist. The hospice interdisciplinary team (medical director, hospice nurse, social worker, chaplain, and home health aides) evaluates the patient, establishes an individualized plan of care, and documents the election of hospice benefit. During the measurement period the patient receives ongoing hospice services including regular home visits by hospice nurses for symptom control, medication management, psychosocial support from social work, spiritual care, and 24/7 on-call nursing support for breakthrough symptoms. The hospice team documents visits, goals of care discussions, and updates to the plan of care in the medical record. Billing occurs under the hospice benefit for services delivered any time during the measurement period, using M1154 to indicate hospice services provided during that period.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Rarely applicable; use if unusually complex administrative or clinical hospice service requires documentation of substantially greater work.

HCPCS M1207: Social Needs Screening for Food, Housing, Transportation, Safety

HCPCS-M1301-TOBACCO-CESSATION-INTERVENTION

HCPCS M1301: Tobacco Cessation Intervention for Identified Tobacco Users

HCPCS-M1460-RESPIRATORY-DIAGNOSES-COPD-EMPHYSEMA-CYSTIC-FIBROSIS-ARF

HCPCS Level II M1460: Respiratory Diagnoses — COPD, Emphysema, Cystic Fibrosis

HCPCS-M1376-RA-ADDITIONAL-ENCOUNTER-90-DAY-RULE

HCPCS Level II M1376: Additional RA Encounter, ≥90 Days

HCPCS-M1280-BILATERAL-MASTECTOMY-HISTORY

HCPCS Level II M1280: Bilateral Mastectomy or History of Bilateral Mastectomy

HCPCS-M1204-INITIAL-SYMPTOM-SEVERITY-ASSESSMENT-NRS-VRS-ITCHYQUANT

HCPCS M1204: Initial Symptom Severity Assessment (NRS/VRS/ItchyQuant)

HCPCS-M1302-DIGITAL-BREAST-TOMOSYNTHESIS-RESULTS-REVIEWED

HCPCS M1302: Digital/3D Mammography Results Documented and Reviewed

HCPCS-M1311-ANAPHYLAXIS-DUE-TO-VACCINE-ACUTE-CARE

HCPCS Level II M1311: Anaphylaxis Due to Vaccine, Acute Care

HCPCS-M1390-MELANOMA-RECURRENCE-EXAM-NOT-DOCUMENTED

HCPCS Level II M1390: Missing Exam for Melanoma Recurrence

HCPCS-M1497-FALLS-NOT-PERFORMED-MEDICAL-REASONS-DOCUMENTATION

HCPCS M1497: Documentation of Falls Not Performed Due to Medical Reasons

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Taxonomy Code	Specialty	Notes
`350200000X`	Hospice and Palliative Medicine	Primary specialty providing and overseeing hospice services.
`207Q00000X`	Family Medicine	Common referring and attending physicians coordinating hospice enrollment and orders.
`208000000X`	Internal Medicine	Hospitalists and primary internists often manage transitions to hospice and ongoing medical oversight.
`363L00000X`	Nurse Practitioner	Advanced practice clinicians who provide home visits, symptom management, and documentation for hospice care.
`367500000X`	Registered Nurse	Hospice nursing staff responsible for direct patient care, symptom assessments, and care coordination.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z51.5`	Encounter for palliative care	Directly indicates palliative focus and is commonly used in hospice contexts.
`C34.90`	Malignant neoplasm of unspecified part of bronchus or lung, unspecified	Advanced lung cancer is a frequent primary diagnosis leading to hospice enrollment.
`I50.9`	Heart failure, unspecified	Progressive heart failure with refractory symptoms commonly triggers hospice referral.
`C71.9`	Malignant neoplasm of brain, unspecified	Advanced neurologic malignancies frequently require hospice for symptom management and end-of-life care.
`G30.9`	Alzheimer's disease, unspecified	End-stage dementia is a common hospice diagnosis for comfort-focused care.
`J44.9`	Chronic obstructive pulmonary disease, unspecified	Advanced COPD with chronic respiratory failure often leads to hospice services.
`N18.6`	End stage renal disease	Patients with ESRD foregoing dialysis or with poor prognosis often receive hospice care.
`R54`	Age-related physical debility	Functional decline and frailty commonly accompany hospice enrollment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99221`	Initial hospital care, typically 30 minutes at bedside	When a patient transfers to inpatient hospice unit, attending physicians may bill initial inpatient evaluation prior to hospice bundle documentation.
`99304`	Nursing facility care, per day, for the evaluation and management of a patient, typically 25 minutes	Used when hospice provides daily management in a nursing facility setting alongside the hospice aggregate billing.
`99341`	Home visit for a new patient, typically 20 minutes	Applied when hospice physicians or advanced practice clinicians perform home visits at the start of hospice care.
`99499`	Unlisted evaluation and management service	Used for reporting atypical or complex hospice-related encounters not described by standard E/M codes when separately billable.
`G0154`	Direct skilled nursing services of a licensed nurse in the home health or hospice setting, per 15 minutes	Often used for time-based skilled nursing visits tied to specific billable interventions within hospice care.

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