Summary & Overview
HCPCS M1269: ESRD MCP Dialysis on Last Day of Reporting Month
HCPCS Level II code M1269 denotes receipt of end-stage renal disease (ESRD) maintenance dialysis care by the provider on the last day of the reporting month. This encounter-level code matters nationally because it supports accurate reporting of dialysis service delivery timing, influences month-end quality and utilization measurement for ESRD programs, and affects claims processing tied to end-of-period service attribution.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical meaning, the typical service setting (outpatient dialysis units), and national implications for billing and reporting. The publication summarizes common modifiers and related billing contexts when available, outlines where this code fits in ESRD service lines, and highlights benchmarks and policy updates relevant to month-end dialysis reporting.
This analysis provides operational clarity for billing staff, clinicians, and administrators on how M1269 is used in claims to indicate dialysis services delivered on the last day of a reporting month, and what to expect in payer coverage and documentation practices. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code M1269 represents receiving ESRD MCP dialysis services by the provider on the last day of the reporting month. This code is used to indicate that a patient with end-stage renal disease (ESRD) received maintenance dialysis care furnished by the provider on the final day of the reporting period.
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Service type: Outpatient dialysis service, ESRD maintenance care
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Typical site of service: Dialysis unit or outpatient dialysis facility
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with end-stage renal disease (ESRD) receives maintenance hemodialysis at an outpatient dialysis facility. On the last day of the reporting month the patient attends an established dialysis session provided by the facility’s nephrology team. The encounter documents that the patient received dialysis care from the facility/provider on that specific date to satisfy monthly reporting requirements for Medicare and other payors. The clinical workflow includes verification of patient identity, vascular access assessment, pre-dialysis vital signs and weights, dialysis treatment delivery and monitoring, documentation of ultrafiltration and hemodynamic responses, and post-dialysis assessment and discharge instructions. The dialysis nurse documents treatment times, complications (if any), medications administered during dialysis, and the provider documents the medical necessity of ongoing ESRD maintenance dialysis. Billing uses the HCPCS Level II code M1269 to indicate that the patient received ESRD maintenance dialysis services from the provider on the last day of the reporting month.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when substantially greater work is required for administrative or clinical complexity related to dialysis services (rare for routine ESRD visits). |