Summary & Overview
HCPCS M1309: Palliative Care Services During Measurement Period
HCPCS Level II code M1309 designates palliative care services delivered to a patient at any point during the measurement period. Nationally, documenting palliative care with a distinct code is important for tracking access to supportive, symptom-focused care for people with serious illness and for measuring quality and service utilization across care settings. Palliative care supports symptom control, advance care planning, and interdisciplinary coordination, which can influence patient outcomes and care trajectories.
Key payers in the national discussion include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of what M1309 captures clinically, the typical sites where these services are delivered, and which payers commonly cover the service. The publication outlines benchmarks and reporting contexts where M1309 is used, summarizes relevant policy and coding considerations for national programs, and provides clinical context for how palliative care is represented in claims data. Data not available in the input where payer-specific rates, taxonomies, and ICD-10 linkage would normally be included.
Billing Code Overview
HCPCS Level II code M1309 represents palliative care services provided to a patient any time during the measurement period. This code denotes the provision of palliative care, which focuses on symptom management, goals-of-care conversations, and supportive services for patients with serious illness.
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Service type: Palliative care services
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Typical site of service: Palliative care may be delivered in a variety of settings, including hospital inpatient units, outpatient clinics, hospice programs, skilled nursing facilities, and home-based care, depending on patient needs and provider arrangements.
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Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult with advanced, life-limiting illness — for example, metastatic lung cancer with progressive dyspnea and uncontrolled pain despite escalating disease‑directed therapy. The patient is seen by a palliative care team during an outpatient clinic visit or during a hospital admission any time during the measurement period to evaluate symptom control, goals of care, and advance care planning. The clinical workflow: initial referral or consultation is placed by the primary team or oncologist; the palliative care clinician (physician, nurse practitioner, or physician assistant) performs a focused assessment of symptoms, psychosocial needs, medication reconciliation, and decision‑making capacity; a plan is documented that addresses symptom management, family communication, and care alignment with patient goals; follow‑up visits or coordination with home hospice, outpatient palliative programs, or community resources are arranged. Typical site of service includes inpatient hospital units, observation, or outpatient palliative care clinics. The service represented by M1309 documents that palliative care services were provided to the patient at any time during the measurement period, regardless of specific billed encounter CPT codes.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When work required is substantially greater than typically required and documented for the palliative care encounter. |