M1254 HCPCS Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS Level II M1254: Patient Deceased on Home Health Survey Contact

HCPCS Level II code M1254 records situations in which patients are found to be deceased when a home health survey or outreach contact reaches them. This administrative code captures the outcome of attempted post-discharge or home outreach contacts and is important for accurate encounter documentation, quality measurement, and administrative reporting at a national level. Proper use of M1254 ensures accurate tracking of outreach efforts and prevents inappropriate follow-up actions.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. These payers commonly require precise encounter coding for home health and post-discharge programs and use such codes in quality assessments, claims processing, and member records.

Readers will learn what M1254 represents, the clinical and administrative context for its use, and where it typically applies (home or the site of outreach). The publication will cover coding benchmarks, documentation expectations, and policy-related considerations that affect national reporting and payer processes. Data fields such as common modifiers and other administrative metadata are provided where available. Data not available in the input will be identified as such.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1254HCPCS Level IIhome healthpost-discharge outreachmortality documentationencounter codingquality measurementadministrative reporting

Billing Code Overview

HCPCS Level II code M1254 denotes encounters where patients were deceased when the home health survey (hu survey) reached them. This code is used to record instances in which the intended recipient of a home health or post-discharge outreach contact is found to be deceased upon attempted survey or visit.

Service type: Post-discharge or outreach contact resulting in determination of patient death
Typical site of service: Home or the location where the outreach/survey was conducted (for example, patient residence or last known address)

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

This HCPCS Level II code M1254 is reported when a patient is confirmed deceased at the time a home health utilization (HU) survey or home health agency contact is attempted. A typical scenario: a home health clinician or agency administrative staff attempt an in-person visit or telephone outreach to a patient enrolled for home health services and discover the patient has died prior to the scheduled encounter. The workflow includes verification of death via next-of-kin, hospice or facility documentation, or death certificate; notification of the referring physician and primary payor(s); updating the patient record to close active episodes of care; and completing any required agency or state-level mortality reporting. Billing uses M1254 to indicate the service could not be delivered because the patient was deceased, and documentation should include date/time of attempted contact, source of death verification, relationship of reporter, and actions taken (care plan closure, notifications, and disposition of equipment or medications). Typical site of service is the patient’s residence or the location where death was discovered (private home, assisted living, skilled nursing facility). Typical patient scenarios include recent discharge to home from hospital or hospice enrollment where death occurs shortly after discharge, or patients receiving ongoing home health who die between scheduled visits.

Coding Specifications

Modifier	Description	When to Use
`22`

HCPCS M1290: Patient Excluded for Active Hypertension

HCPCS-M1438-TIME-LAST-KNOWN-WELL-TO-HOSPITAL-ARRIVAL-210-MINUTES-OR-LESS

HCPCS Level II M1438: Time Last Known Well to Hospital Arrival ≤ 210 Minutes

HCPCS-M1468-HEPATITIS-B-VACCINATION-COMPLETED-AGE-APPROPRIATE-DOSES

HCPCS M1468: Hepatitis B Vaccination, Age-Appropriate Doses

HCPCS-M1180-IMMUNE-CHECKPOINT-INHIBITOR-THERAPY-MONITORING

HCPCS M1180: Patients on Immune Checkpoint Inhibitor Therapy

HCPCS-M1219-ANAPHYLAXIS-VACCINE-REACTION-ENCOUNTER

HCPCS Level II M1219: Anaphylaxis Due to Vaccine on or Before Encounter Date

HCPCS-M1187-END-STAGE-RENAL-DISEASE-ESRD-CARE

HCPCS M1187: End Stage Renal Disease (ESRD) Care

HCPCS-M1436-TELEHEALTH-ENCOUNTER-REMOTE-SERVICE

HCPCS Level II M1436: Telehealth Encounter

HCPCS-M1325-NOT-SEEN-CLINICIAN-DOCUMENTED-MEDICAL-REASONS

HCPCS Level II M1325: Clinician-Documented Patient Not Seen for Ophthalmic Reasons

HCPCS-M1421-DERMATOLOGY-MIPS-VALUE-PATHWAY

HCPCS Level II M1421: Dermatology MIPS Value Pathway

HCPCS-M1406-PATIENTS-LEAVE-PRACTICE-DURING-FOLLOW-UP

HCPCS Level II M1406: Patients Who Leave Practice During Follow-Up

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Taxonomy Code	Specialty	Notes
`251B00000X`	Home Health Agency	Primary provider setting performing enrollment and verification activities.
`251S00000X`	Home Health Care	Clinicians providing skilled nursing or therapy services who may document death during routine visits.
`207Q00000X`	Hospice and Palliative Medicine	Often involved when death occurs in hospice patients and coordination is required.
`1835S0105X`	Nurse Practitioner	Advanced practice clinicians who may perform home visits and document mortality.
`163W00000X`	Nurse	Registered nurses who commonly perform the verification and documentation tasks

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	May represent prior routine E/M visits in the home health workflow; documented visits before discovery of death.
`99341`	Home visit for the evaluation and management of a new patient, typically 20 minutes	Commonly used for in-home E/M visits that may be scheduled and then canceled due to patient death.
`99347`	Home visit for the evaluation and management of an established patient, typically 20 minutes	Used for recurring home visits that may be impacted when a patient is found deceased.
`99358`	Prolonged evaluation and management service before and/or after direct patient care; first hour	May be used when extensive administrative time is required for coordination and documentation after a patient’s death.
`99499`	Unlisted evaluation and management service	May be used when none of the standard E/M codes accurately describe the postmortem administrative work for payers that require a CPT entry.

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