M1307 Palliative/Hospice Documentation Reimbursement | OpenPayer

Summary & Overview

HCPCS M1307: Documentation of Palliative or Hospice Care

HCPCS Level II code M1307 denotes documentation that a patient has received or is currently receiving palliative or hospice care. Nationally, clear documentation of palliative or hospice status affects care coordination, continuity, and appropriate service delivery across settings where end-of-life or comfort-focused care is provided. The code does not describe delivery of clinical services itself but confirms the patient’s care status in the medical record.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for using M1307, common modifier practice where available, and the typical sites where documentation is recorded. The publication summarizes what documentation this code reflects and why it matters for billing, authorization, and transitions of care.

This report provides benchmarks and policy context where available, explains how M1307 aligns with palliative and hospice workflows, and flags areas where data was not supplied. Data not available in the input is noted explicitly. The content is intended for national audiences including coding professionals, revenue cycle staff, and clinical leaders seeking a concise reference on HCPCS Level II code M1307 and its role in documenting palliative or hospice care.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1307HCPCS Level IIpalliative carehospice caredocumentationbillingend-of-life care

Billing Code Overview

HCPCS Level II code M1307 documents that a patient has received or is currently receiving palliative or hospice care. This code represents written documentation confirming a patient's enrollment in palliative or hospice services and is used to indicate that the patient's medical record reflects that status.

Service Type: Palliative or Hospice Care Documentation

Typical Site of Service: Hospice facilities, inpatient hospital hospice units, outpatient palliative care clinics, and home hospice settings

Clinical & Coding Specifications

Clinical Context

A common scenario involves an adult patient with advanced, life-limiting illness (for example, metastatic cancer, end-stage heart failure, or progressive neurodegenerative disease) who is either enrolled in a hospice program or receiving palliative care services. The patient is seen by a clinician—often in an outpatient clinic, home visit, inpatient acute care facility, long-term care facility, or hospice residence—where documentation is required to record that the patient has received or is currently receiving palliative or hospice care. Typical workflow: the clinician reviews the patient’s goals of care, symptom burden, and current treatment plan; confirms enrollment or active participation in a hospice or palliative care program; documents the nature and date of palliative/hospice services; and includes relevant clinical details (prognosis, advanced care planning, medications for symptom control, and interdisciplinary care coordination). That documentation supports use of billing code M1307 to indicate the patient has received or is currently receiving palliative or hospice care and is commonly included in encounters where care decisions, symptom management, or transitions to comfort-focused care are discussed.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the service required substantially greater work than typically required (e.g., extended counseling during palliative goals-of-care discussions).

HCPCS Level II M1148: Ongoing Care Not Possible Due to Patient Self-Discharge

HCPCS-M1472-HEPATITIS-B-VACCINATION-INCOMPLETE-DOSES

HCPCS Level II M1472: Incomplete Hepatitis B Vaccination by Age

HCPCS-M1350-SUICIDE-SAFETY-PLAN-INITIATED-REVIEWED-UPDATED

HCPCS M1350: Suicide Safety Plan Initiation, Review, or Update

HCPCS-M1303-HOSPICE-SERVICES-MEASUREMENT-PERIOD

HCPCS M1303: Hospice Services During Measurement Period

HCPCS-M1446-PATIENT-DEATH-DURING-MEASURE-PERIOD

HCPCS Level II M1446: Patient Death During Measure Assessment Period

HCPCS-M1223-GLAUCOMA-PLAN-OF-CARE

HCPCS M1223: Glaucoma Plan of Care Documented

HCPCS-M1253-AMBULATORY-PALLIATIVE-CARE-PATIENT-DISAVOWAL

HCPCS M1253: Ambulatory Palliative Care Patient Disavowal

HCPCS-M1342-PATIENTS-WHO-DIED-DURING-PERFORMANCE-PERIOD

HCPCS Level II M1342: Patients Who Died During Performance Period

HCPCS-M1473-ASSESSMENT-IMPACTING-FUNCTIONAL-MEASURE-VALIDITY

HCPCS M1473: Factors Affecting Validity of Functional/Cognitive Assessments

HCPCS-M1249-PATIENT-UNDERSTANDS-IMPORTANT-TO-ME

HCPCS Level II M1249: Patient-reported Understanding of What Matters

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Taxonomy Code	Specialty	Notes
`363500000X`	Hospice and Palliative Medicine Physician	Physicians specialized in hospice and palliative care who commonly document and manage these patients.
`207L00000X`	Internal Medicine	Hospitalists and outpatient internists who often provide palliative care documentation and coordination.
`207Q00000X`	Family Medicine	Primary care physicians providing advance care planning and hospice/palliative documentation.
`378N00000X`	Nurse Practitioner	NPs who perform assessments, symptom management, and document palliative/hospice care.
`163W00000X`	Social Worker	Licensed clinical social workers involved in hospice/palliative care coordination and documentation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C80.1`	Malignant (primary) neoplasm, unspecified site, with metastasis	Advanced metastatic cancer frequently triggers palliative care or hospice enrollment and documentation.
`I50.9`	Heart failure, unspecified	End-stage heart failure patients often receive palliative care for symptom control and goals-of-care discussions.
`G30.9`	Alzheimer disease, unspecified	Progressive neurodegenerative diseases may lead to hospice enrollment and require documentation of palliative services.
`J96.00`	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	Respiratory failure in advanced disease often prompts palliative-focused decisions and hospice consideration.
`N18.6`	End stage renal disease	Patients with ESRD who elect comfort-focused care or hospice require documentation of palliative services.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Commonly used for outpatient encounters where palliative or hospice care status is assessed and documented; supports medical decision-making and counseling.
`99341`	Home visit for the evaluation and management of a new patient	Used when clinicians perform home visits to assess and document hospice or palliative care needs and enrollment.
`99497`	Advance care planning including the explanation and discussion of advance directives, first 30 minutes	Often performed alongside documentation of palliative/hospice care when goals-of-care and advance directives are reviewed and recorded.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes	Example of counseling codes that may be used during palliative care visits for symptomatic counseling; supportive but ancillary.
`99307`	Subsequent nursing facility care, per day, for the evaluation and management of a patient	Used when documenting palliative/hospice care for patients residing in nursing facilities where daily or periodic assessments are performed.

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