Summary & Overview
HCPCS M1187: End Stage Renal Disease (ESRD) Care
HCPCS Level II code M1187 denotes services for patients diagnosed with end stage renal disease (ESRD). Nationally, accurate use of this code matters for tracking ESRD-related service utilization, coordinating dialysis and specialty care, and ensuring appropriate claims processing for a high-cost, high-complexity patient population. This code supports clinical documentation and payer adjudication for encounters centered on ESRD management.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes how payers approach coverage and coding for ESRD-related services and highlights typical sites of service such as hospital outpatient departments and dialysis centers.
Readers will learn the clinical context for using M1187, common billing and administrative considerations, and where to find related coding guidance. The report presents national benchmarks and policy-relevant updates where available, and clarifies which data elements are present or absent in the input. Data not available in the input will be explicitly noted in relevant sections.
Billing Code Overview
HCPCS Level II code M1187 indicates services related to patients with a diagnosis of end stage renal disease (ESRD). The code reflects care specifically associated with the ESRD patient population and is used to identify services and resource use tied to that diagnosis.
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Service type: Services for management and support of end stage renal disease, including dialysis-related care and coordination
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Typical site of service: Hospital outpatient departments, dialysis centers, and other ambulatory settings where ESRD treatment and monitoring occur
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with established end stage renal disease (ESRD) maintained on thrice-weekly hemodialysis presents for routine outpatient dialysis treatment billed under M1187. The typical workflow begins with pre-dialysis nursing assessment (vital signs, weight, review of interdialytic symptoms), verification of vascular access (arteriovenous fistula, graft, or tunneled hemodialysis catheter), medication reconciliation including anticoagulation and erythropoiesis-stimulating agents, and documentation of dialysis prescription (blood flow rate, dialysate composition, ultrafiltration goal). During the session, nursing and dialysis staff monitor hemodynamics, satisfy dialysis machine quality checks, and address access or intradialytic complications (hypotension, cramping, bleeding, access dysfunction). Post-dialysis activities include provision of discharge instructions, recording post-treatment weight, and arranging follow-up nephrology or access interventions as needed. Typical sites of service are outpatient dialysis centers, hospital-based dialysis units, and long-term care facility dialysis services. Common patient scenario modifiers include clinical complexity (e.g., prolonged or unusually complex dialysis) or services impacted by patient's condition (e.g., patient on mechanical ventilation or with concurrent procedures).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |