HCPCS M1303: Hospice Services During Measurement Period - OpenPayer

Summary & Overview

HCPCS M1303: Hospice Services During Measurement Period

HCPCS Level II code M1303 designates that a patient received hospice services at any time during the measurement period. Nationally, tracking hospice utilization is important for assessing end-of-life care access, quality measurement, and care coordination across settings. Hospice claims marked with M1303 indicate that palliative and supportive care services were furnished under a hospice benefit, which has implications for care planning and quality reporting.

Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical meaning, typical sites of service, and the areas where this code is used in quality measurement and encounter reporting. The publication summarizes available benchmarks and payer coverage patterns when present, highlights relevant policy and reporting contexts tied to hospice measures, and outlines typical billing considerations for inclusion in quality measurement denominators and numerators.

This national-level summary is intended for billing managers, policy analysts, and clinicians who need a clear reference for what M1303 represents, which payers commonly track it, and what topics to review further (benchmarks, payer reporting requirements, and clinical context). Data not available in the input are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1303HCPCS Level IIHospicePalliative CareQuality MeasurementEncounter ReportingEnd-of-Life CareCare Coordination

Billing Code Overview

HCPCS Level II code M1303 represents hospice services provided to a patient at any time during the measurement period. This code denotes the provision of hospice care, which emphasizes palliative and supportive services for patients with life-limiting illness.

Service type: Hospice services
Typical site of service: Hospice setting or any location where hospice care is delivered, including the patient’s residence, inpatient hospice facility, or hospital when hospice is active.

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A typical patient receiving hospice services under M1303 is an adult with a terminal, life-limiting illness for whom curative treatment has been discontinued and who has elected comfort-focused care. Example scenario: an 82-year-old patient with advanced metastatic lung cancer, progressive functional decline, and persistent symptoms (dyspnea, pain, decreased oral intake) elects hospice enrollment. The hospice interdisciplinary team conducts an initial comprehensive assessment, establishes a plan of care, provides bereavement and psychosocial support, manages symptoms with medication and durable medical equipment, and coordinates care across the home, inpatient hospice unit, or nursing facility during the measurement period. Documentation includes the hospice election statement, comprehensive assessment, certification of terminal prognosis by the attending provider, individualized plan of care, medication and symptom management records, visit notes from nursing and hospice aides, and records of any inpatient respite or continuous home care episodes. Billing under M1303 indicates hospice services were provided at any time during the measurement period and is used to capture hospice enrollment and service delivery across settings (home, nursing facility, or inpatient hospice).

Coding Specifications

Modifier	Description	When to Use
`22`

HCPCS M1374: Additional Rheumatoid Arthritis Encounter, 90+ Days

HCPCS-M1310-TOBACCO-CESSATION-SCREENING-AND-INTERVENTION

HCPCS Level II M1310: Tobacco Use Screening and Cessation Intervention

HCPCS-M1228-HCV-TREATMENT-INITIATION-AFTER-VIREMIA

HCPCS M1228: HCV Treatment Initiation Within 3 Months of Reactive Antibody Test

HCPCS-M1229-HCV-VIREMIA-REFERRAL-TO-HCV-CLINICIAN

HCPCS Level II M1229: Referral for HCV Viremia to HCV Clinician

HCPCS-M1147-ONGOING-CARE-DISCONTINUED-DUE-TO-HOSPITALIZATION-OR-SURGERY

HCPCS M1147: Ongoing Care Discontinued Due to Hospitalization or Surgery

HCPCS-M1479-ASSESSMENT-IMPACT-FUNCTIONAL-CAPACITY-MOTIVATION

HCPCS M1479: Assessment Impacted by Functional Capacity or Motivation

HCPCS-M1289-TOBACCO-USER-NO-CESSATION-INTERVENTION

HCPCS M1289: Tobacco User Without Cessation Intervention

HCPCS-M1197-ITCH-SEVERITY-ASSESSMENT-SCORE-IMPROVEMENT

HCPCS M1197: Itch Severity Assessment, 3+ Point Improvement

HCPCS-M1327-INADEQUATE-INITIAL-EVALUATION-OR-MISSED-8-WEEK-REEVALUATION

HCPCS Level II M1327: Inadequate Initial Evaluation or Missed 8‑Week Re-evaluation

HCPCS-M1463-POST-TREATMENT-FOLLOW-UP-CARE-COORDINATION

HCPCS Level II M1463: Documentation of Post-Treatment Follow-Up Attempts

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Taxonomy Code	Specialty	Notes
`251M00000X`	Hospice and Palliative Medicine Physician	Primary clinical leads for hospice patient certification, symptom management, and care planning.
`330100000X`	Registered Nurse (General)	Provides nursing assessments, symptom management, and documentation for hospice services.
`367A00000X`	Nurse Practitioner	Provides primary hospice care, assessments, and medication management under scope of practice.
`332B00000X`	Licensed Practical/Vocational Nurse	Provides direct care, personal care support, and documentation in home or facility settings.
`334N00000X`	Social Worker	Provides psychosocial assessments, counseling, and bereavement services within the hospice interdisciplinary team.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C34.90`	Malignant neoplasm of unspecified part of bronchus or lung, unspecified	Advanced lung cancer is a common primary diagnosis leading to hospice enrollment for symptom management and comfort care.
`C78.7`	Secondary malignant neoplasm of liver and intrahepatic bile duct	Metastatic disease with progressive organ dysfunction often prompts transition to hospice care.
`I50.9`	Heart failure, unspecified	Advanced congestive heart failure with refractory symptoms is a frequent hospice diagnosis.
`G30.9`	Alzheimer's disease, unspecified	Advanced dementia with functional decline and need for palliative support is a common hospice indication.
`J44.9`	Chronic obstructive pulmonary disease, unspecified	End-stage COPD with frequent exacerbations and oxygen dependence commonly results in hospice enrollment.
`N18.6`	End stage renal disease	Patients with ESRD who forgo dialysis or have refractory symptoms may receive hospice services.
`C91.50`	Chronic lymphocytic leukemia/small lymphocytic leukemia not having achieved remission	Hematologic malignancies in terminal phases are commonly associated with hospice care.
`R54`	Age-related physical debility	Functional decline and frailty often accompany hospice admission for goal-concordant, comfort-directed care.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99377`	Physician oversight of hospice care/supervision for the dying patient, per day	Used when physicians provide oversight or daily supervision for hospice patients; complements hospice service reporting.
`99378`	Physician oversight of hospice care/supervision for the dying patient, extended services	Used for more extensive physician oversight or prolonged interdisciplinary coordination for hospice patients.
`99497`	Advance care planning including the explanation and discussion of advance directives, first 30 minutes	Often performed during hospice enrollment or early hospice visits to document goals of care and advance directives.
`99498`	Advance care planning, each additional 30 minutes	Used when advance care planning requires additional time during hospice admission or reassessment.
`G0182`	Recognition of terminal illness; face-to-face visit to determine eligibility for hospice care (Medicare)	Performed to document Medicare hospice eligibility and support the hospice election and certification process.

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