Summary & Overview
HCPCS M1159: Hospice Services During Measurement Period
HCPCS Level II code M1159 designates that a patient received hospice services at any point during the measurement period. This administrative code is used in reporting and quality measurement to capture hospice care delivery across clinical settings. Nationally, accurate capture of hospice encounters is important for hospice utilization metrics, quality reporting, and population-level assessments of end-of-life care.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code's clinical meaning and typical sites of service, benchmarks for hospice service capture where available, and relevant policy considerations that affect coding and reporting. The discussion also outlines common modifier usage and notes when data elements are not provided.
The publication provides context for coding teams, quality and compliance staff, and policy analysts seeking a concise reference on M1159. It highlights where this code fits in measurement frameworks and what documentation elements typically support its use. Data not provided in the input are clearly indicated so readers understand which aspects require local validation or payer-specific guidance.
Billing Code Overview
HCPCS Level II code M1159 represents hospice services provided to a patient any time during the measurement period. The code denotes the occurrence of hospice care delivery during the reporting window and is used to indicate that a patient received hospice services.
-
Service type: Hospice care services
-
Typical site of service: Hospice facility, patient's home, or other site where hospice services are delivered
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a life-limiting illness (for example, advanced metastatic cancer, end-stage heart failure, end-stage chronic obstructive pulmonary disease, or advanced neurodegenerative disease) who receives hospice services any time during the measurement period. The clinical workflow begins when the patient or family elects hospice care and a hospice physician or interdisciplinary team performs a hospice eligibility assessment, documents the terminal diagnosis and prognosis, and initiates hospice plan of care. The hospice interdisciplinary group (physician, nurse, social worker, chaplain, and aide) provides symptom management, psychosocial support, caregiver education, coordination of durable medical equipment and medications related to palliation, and respite services as needed. Documentation includes hospice election forms, face-to-face encounters, plan of care reviews, interdisciplinary notes, medication and supply orders, and discharge or death summaries. Billing uses hospice-level reporting to indicate that the patient received hospice services during the measurement period using the hospice HCPCS Level II code M1159.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When additional work or complexity beyond usual hospice service documentation occurs and payer allows modifier on hospice-related professional claims |