Summary & Overview
HCPCS M1157: Bone Marrow Transplant During Measurement Period
HCPCS Level II code M1157 documents that a patient received a bone marrow transplant at any point during the measurement period. This designation captures a high‑acuity, resource‑intensive clinical event that is clinically significant for care coordination, outcomes measurement, and payer policy because it signals major treatment for hematologic malignancy or other transplant‑eligible conditions.
Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what M1157 represents, the typical clinical and site‑of‑care context, and how the code is used in claims to identify transplant recipients for quality measurement and utilization tracking. The publication highlights common billing considerations and prevalence implications for national payer populations.
The content outlines benchmarks and reporting uses relevant to quality measurement and utilization management, summarizes recent policy and claim reporting considerations where available, and provides clinical context for interpreting claims coded with M1157. Data not available in the input is noted where applicable. The guidance is intended for billing professionals, payers, and policy analysts seeking a clear, national overview of the code and its implications for measurement and reporting.
Billing Code Overview
HCPCS Level II code M1157 indicates that a patient received a bone marrow transplant any time during the measurement period. This code documents the occurrence of a bone marrow transplant procedure or service during the relevant reporting timeframe.
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Service type: Bone marrow transplant procedure or associated transplant services
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Typical site of service: Inpatient hospital or specialized transplant center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with high‑risk acute myeloid leukemia (AML) is admitted to an academic medical center for an allogeneic bone marrow transplant during the measurement period. The clinical workflow begins with pre‑transplant evaluation including HLA typing, infectious disease screening, cardiac and pulmonary clearance, and central venous access placement. The patient receives myeloablative conditioning chemotherapy and/or total body irradiation followed by infusion of donor hematopoietic stem cells (bone marrow) in the inpatient transplant unit. Immediate post‑transplant care includes close monitoring for infusion reactions, neutropenic fever, graft‑versus‑host disease (GVHD), fluid and electrolyte management, transfusion support, and antimicrobial prophylaxis. Outpatient follow‑up visits occur frequently in the first 100 days for GVHD assessment, immunosuppression management, and surveillance labs. Billing for the transplant event is captured by the HCPCS Level II code M1157 indicating the patient received a bone marrow transplant during the measurement period.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or technical effort substantially exceeds usual for transplant‑related procedures (rare for coded transplant event). |