Summary & Overview

HCPCS Level II M1186: Hospice or Palliative Care Order/Receiving

HCPCS Level II code M1186 designates patients who have an order for or are receiving hospice or palliative care. Its use flags encounters focused on comfort-oriented care, symptom management, and supportive services across settings where end-of-life or serious-illness management is provided. Nationally, consistent use of this code supports clinical documentation, care coordination, and payer processing for services aligned with hospice and palliative treatment goals.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical context, expected service settings, and common billing considerations. The content also outlines typical payer coverage landscape and what organizations commonly track when this code is present on a claim.

The publication provides benchmarks for utilization where available, summaries of relevant policy and billing practice updates, and practical clarifications on clinical context for coding teams. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1186HCPCS Level IIhospice carepalliative careend-of-life carebillingclaims codingcare coordinationclinical documentation

Billing Code Overview

HCPCS Level II code M1186 indicates patients who have an order for or are receiving hospice or palliative care. The code is used to identify patients under care plans focused on comfort, symptom management, and supportive services rather than curative treatment.

Service Type: Palliative and hospice care services

Typical Site of Service: Inpatient hospice units, hospice agencies, palliative care teams in hospitals, and patients' homes

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with a life-limiting illness (for example, metastatic cancer, end-stage heart failure, advanced chronic obstructive pulmonary disease, or progressive neurodegenerative disease) who has a standing order for or is actively receiving hospice or palliative care services and requires documentation of that status for billing or care-coordination purposes. The clinical workflow begins when the treating physician or hospice medical director documents eligibility for hospice or initiation of palliative-focused services in the medical record. A hospice order or certification is placed in the chart, the hospice team (including hospice nurse, social worker, and hospice aide) coordinates home or inpatient hospice services, and the ordering provider includes the hospice/palliative status on encounters, orders, and claims using billing code M1186. Encounters commonly occur in the home, hospice inpatient facilities, long-term care or skilled nursing facilities, or hospital settings when transitioning to comfort-focused care. Clinical documentation includes the hospice initiation order, prognosis or certification (as required by payors), goals-of-care discussion, plan for medications and symptomatic management, and updates to the problem list noting the primary palliative diagnosis and related comorbidities.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased Procedural Services

Taxonomy Code	Specialty	Notes
`185D00000X`	Hospice and Palliative Medicine	Primary specialty providing and certifying hospice/palliative care services.
`207K00000X`	Family Medicine	Frequently certifies hospice eligibility and coordinates community-based palliative care.
`207P00000X`	Internal Medicine	Hospital- and clinic-based physicians who manage palliative needs and hospice certifications.
`363L00000X`	Nurse Practitioner	Advanced practice clinicians who frequently document hospice orders and ongoing palliative management.
`193200000X`	Registered Nurse	Nurses deliver direct hospice care and documentation; taxonomy reflects nursing role in hospice service delivery.

ICD-10 Code	Description	Clinical Relevance
`C80.1`	Malignant neoplasm, unspecified, with multiple sites	Common terminal oncologic diagnosis leading to hospice enrollment for symptom management and comfort care.
`I50.9`	Heart failure, unspecified	Advanced congestive heart failure is a frequent non-oncologic reason for hospice services when refractory to curative therapy.
`J44.9`	Chronic obstructive pulmonary disease, unspecified	End-stage COPD with dyspnea and frequent exacerbations is a typical palliative/hospice diagnosis.
`G30.9`	Alzheimer's disease, unspecified	Advanced neurodegenerative disease leading to functional decline and need for hospice-level care.
`N18.6`	End stage renal disease	Patients with ESRD who forgo dialysis or whose disease progresses may elect hospice or palliative-focused management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99497`	Advance care planning including the explanation and discussion of advance directives, by the physician or other qualified health professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate	Often performed before or at the time of hospice enrollment to document goals of care and advance directives supporting the hospice order.
`99498`	Advance care planning including the explanation and discussion of advance directives, each additional 30 minutes (List separately in addition to code for primary procedure)	Used when advance care planning requires additional time beyond the initial 30 minutes during hospice or palliative consultations.
`99377`	Physician supervision of hospice care provided in the home, per day (subsequent hospice care visit)	Used for periodic physician hospice visits documented for ongoing hospice certification and management.
`99378`	Physician supervision of hospice care provided in an inpatient hospice facility, per day (initial or subsequent)	Used when hospice care is delivered in an inpatient hospice facility and physician supervision is billed.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes	Example of a brief counseling service that might be provided in palliative settings when relevant to symptom management or counseling; not specific to hospice status but commonly performed in clinical workflows.

OpenPayer