Summary & Overview
HCPCS Level II M1416: Patient Received Hospice Services During Performance Period
HCPCS Level II code M1416 documents that a patient received hospice services at any time during the performance period. Nationally, this code is used in quality reporting and administrative records to capture hospice engagement for patients with serious, life-limiting conditions. Accurate use of M1416 supports measurement of end-of-life care access and continuity across payers and care settings.
This analysis covers major national payers including 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 implications for quality reporting and claims workflows. The publication also provides benchmarking context where available, notes on payer coverage patterns, and relevant policy or reporting considerations that affect hospice service documentation.
Intended audiences include health plans, provider billing teams, quality measurement staff, and health policy analysts seeking a national perspective on hospice service capture and reporting. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code M1416 indicates that a patient received hospice services at any time during the performance period. The service type is hospice care, which encompasses palliative care and supportive services focused on comfort and quality of life for patients with life-limiting illnesses. The typical site of service is hospice setting or the patient’s place of residence (home, hospice facility, or long-term care facility).
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Clinical & Coding Specifications
Clinical Context
Patient is a 78-year-old male with advanced metastatic lung cancer and progressive functional decline who enrolled in a hospice program during the current performance period. Hospice services are provided by an interdisciplinary hospice team including hospice physician or nurse practitioner, registered nurses, licensed practical nurses, hospice aides, social worker, chaplain, and bereavement counselors. The workflow begins with hospice eligibility determination (physician certification of terminal prognosis, typically ≤6 months if disease follows usual course), completion of the hospice election and plan of care, and initiation of routine or continuous home hospice services as clinically indicated. Typical encounters include initial comprehensive assessment, symptom management visits (pain, dyspnea, nausea), medication management, equipment and supply provision, caregiver education, and periodic interdisciplinary team meetings to update the plan of care. Documentation supporting billing for M1416 includes the hospice admission note, physician certification, plan of care, progress notes showing at least one hospice service provided during the reporting/performance period, and any relevant face-to-face encounters or telehealth contacts documenting active hospice services.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typically required for hospice-related procedures or services documented in addition to routine hospice care (rare). |