HCPCS M1458: Patient Died Prior to End of Performance Period - OpenPayer

Summary & Overview

HCPCS M1458: Patient Died Prior to End of Performance Period

HCPCS Level II code M1458 records that a patient died prior to the end of a defined performance period. Nationally, accurate use of M1458 matters for quality measurement, episode-based payment reconciliation, and administrative reporting when patient mortality truncates a performance window. Proper coding affects performance metrics, program compliance, and downstream claims adjudication.

This summary covers major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how M1458 is defined, common clinical contexts where it is applied, and what readers can expect regarding documentation expectations and reporting implications.

Readers will learn benchmark-focused guidance on where M1458 appears in billing workflows, the clinical scenarios that commonly lead to its use (for example, death during an inpatient stay or while receiving home health services), and high-level policy considerations that influence payer handling of truncated performance periods. Data not available in the input is noted where specific payer policies, modifiers, taxonomies, ICD-10 mappings, and related codes would normally be detailed.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1458HCPCS Level IImortalityperformance periodepisode terminationbilling statusadministrative codequality measurement

Billing Code Overview

HCPCS Level II code M1458 denotes that the patient died prior to the end of the performance period. This code indicates a terminated episode of care due to patient death and is used to document that the expected performance period was not completed for clinical or administrative reporting.

Service type: End-of-episode administrative status related to mortality
Typical site of service: Any setting where the performance period was being measured (inpatient, outpatient, home health, or other care settings)

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves a patient enrolled in a time-limited home health or hospice episode who dies before the scheduled end of the performance period. Example: an 82-year-old hospice patient with advanced metastatic lung cancer enrolled in a 60-day hospice certification period dies on day 23 of the period. The hospice clinical team documents death, notifies the primary physician and payer, completes required death and disposition records, and prepares final claims. Billing staff submit the appropriate HCPCS Level II code M1458 to indicate that the patient died prior to the end of the performance period, ensuring accurate end-of-care reporting and reconciliation of payments. Clinical workflow steps include verification of death, completion of the death certificate and hospice discharge due to death forms, updating the electronic medical record and plan of care end date, and communicating with payers and family regarding final billing and benefit status.

Coding Specifications

Modifier	Description	When to Use
`24`	Unrelated evaluation and management service by the same physician during a postoperative period	Use if an unrelated E/M service is provided after the hospice/performance period start before death and needs separate payment (rare in hospice claims).

HCPCS M1195: Surgical Pathology Report Missing MMR/MSI Impression or Recommendation

HCPCS-M1331-RE-EVALUATION-WITHIN-8-WEEKS

HCPCS M1331: Re-evaluation Within Eight Weeks

HCPCS-M1422-GASTROENTEROLOGY-MIPS-VALUE-PATHWAY

HCPCS M1422: Gastroenterology Care MIPS Value Pathway

HCPCS-M1437-TELEHEALTH-ENCOUNTER

HCPCS M1437: Encounters Conducted via Telehealth

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

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

HCPCS-M1265-CMS-MEDICAL-EVIDENCE-FORM-2728-INITIAL

HCPCS M1265: CMS Medical Evidence Form 2728, Initial Completion

HCPCS-M1238-RECOMBINANT-ZOSTER-DELAYED-SECOND-DOSE-DOCUMENTATION

HCPCS Level II M1238: Documentation of Delayed Second Recombinant Zoster Dose

HCPCS-M1415-NO-POSITIVE-PD-L1-BEFORE-FIRST-LINE-IMMUNOTHERAPY

HCPCS Level II M1415: No Positive PD-L1 Before First-Line Immunotherapy

HCPCS-M1336-SHORT-INTERVAL-REEVALUATION-IN-OUTPATIENT-SETTING

HCPCS Level II M1336: Re-evaluation within 2 Weeks of Initial Exam

HCPCS-M1309-PALLIATIVE-CARE-SERVICES-MEASUREMENT-PERIOD

HCPCS M1309: Palliative Care Services During Measurement Period

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Taxonomy Code	Specialty	Notes
`251B00000X`	Hospice and Palliative Medicine	Primary specialty responsible for hospice certification, care plan, and death documentation.
`363L00000X`	Family Medicine	Common attending or medical director overseeing end-of-life care and final certifications.
`207Q00000X`	Internal Medicine	Hospital-based or clinic physicians who manage terminal illnesses and certify hospice eligibility.
`2080P0217X`	Geriatric Medicine	Specialists frequently involved in hospice care coordination for elderly patients.
`261QM0800X`	Registered Nurse (RN)	Nursing professionals who verify death, complete documentation, and coordinate discharge due to death.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z66`	Do not resuscitate (DNR) status	Indicates documented end-of-life preference often present in hospice patients and relevant when death occurs during the performance period.
`C34.90`	Malignant neoplasm of unspecified part of unspecified bronchus or lung	Common terminal diagnosis leading to hospice enrollment and potential reason for reporting `M1458` when death occurs.
`I50.9`	Heart failure, unspecified	Frequently a terminal condition resulting in hospice care and death prior to the end of a performance period.
`F03.90`	Unspecified dementia without behavioral disturbance	Dementia is a common hospice diagnosis; death during a certification period would be reported with `M1458`.
`G30.9`	Alzheimer disease, unspecified	A common primary end-of-life diagnosis among hospice patients and relevant to hospice discharge due to death.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99377`	Physician certification statement provided to hospice or home care agency, per certification period	Often used for initial or subsequent hospice certification and may be present in the chart when `M1458` is reported to indicate the certification status prior to death.
`99378`	Follow-up physician certification for hospice, per certification period	Used for periodic recertifications; indicates monitoring that may precede the death documented by `M1458`.
`99499`	Unlisted evaluation and management service	Occasionally used for non-standard, hospice-related E/M services around time of death when no specific CPT applies.
`99223`	Initial hospital care, typically 70 minutes or more	May be used if the patient was admitted and hospital care was provided prior to death; relevant when documenting services before hospice discharge due to death.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes	Included as an example of a common outpatient counseling code; may appear in the record historically but not directly related to death reporting.

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