Summary & Overview
HCPCS M1167: In Hospice or Using Hospice Services During Measurement Period
HCPCS Level II code M1167 denotes that a patient was in hospice or using hospice services during the measurement period. Nationally, identification of hospice status matters for quality measurement, care coordination, and appropriate exclusions from certain performance metrics. Hospice enrollment can affect service utilization patterns and payment considerations across public and commercial programs.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, the types of settings where it applies, and how hospice status is captured for measurement and administrative purposes. The report outlines common billing considerations, available benchmarks where applicable, and recent policy clarifications affecting hospice reporting.
This summary frames what users will learn: the definition and use of HCPCS Level II code M1167, the implications of hospice designation for national quality measures and billing workflows, and where to look for payer-specific guidance. Data not available in the input are noted when relevant.
Billing Code Overview
HCPCS Level II code M1167 indicates that a patient was in hospice or using hospice services during the measurement period. This billing descriptor reflects the status of hospice enrollment or use of hospice-provided care.
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Service type: Hospice care services
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Typical site of service: Hospice settings or any care setting where hospice services are being delivered (including home hospice and inpatient hospice facilities)
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 older adult with a life-limiting illness (for example, advanced metastatic cancer, end-stage heart failure, or progressive neurodegenerative disease) who has elected hospice care. During the measurement period the patient is enrolled in hospice or receiving hospice services; encounters include home hospice visits by hospice nurses, social workers, or physicians; interdisciplinary team meetings; and coordination with primary or specialty clinicians. Documentation captures hospice enrollment dates, attending physician, terminal prognosis, advance care planning, goals of care conversations, and visits or services delivered by the hospice interdisciplinary team. The billing code M1167 is used to indicate the patient was in hospice or receiving hospice services during the measurement period and typically appears on claims from hospice agencies, home health agencies coordinating with hospice, or outpatient clinics documenting hospice status for quality measurement and care coordination.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
52 | Reduced services | When services are partially reduced or discontinued at the physician's discretion for a hospice patient |
53 |