M1481 Hospice/Palliative Care HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS M1481: Hospice or Palliative Care or Deceased During Measurement Period

HCPCS Level II code M1481 denotes patients who received hospice or palliative care or who died during the measurement period. The code is used in quality measurement and administrative reporting to capture end-of-life care status and is relevant for population health monitoring, quality assessment, and care coordination efforts across care settings. Nationally, accurately identifying this cohort supports measurement of care quality for seriously ill patients and informs programmatic and payer-level assessments.

Key payers included in this coverage are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of what M1481 represents, typical settings where the code applies, and the policy and clinical context that make the code important for quality measurement. The publication outlines payer coverage considerations, typical use cases in measurement programs, and the implications for reporting and performance measurement. If specific supplemental data (modifiers, taxonomies, ICD-10 mappings, or related service-line details) are not present in the source material, those items are noted as "Data not available in the input." The content is intended for a national audience involved in billing, quality measurement, and health policy related to hospice and palliative care.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1481HCPCS Level IIhospice carepalliative carequality measurementend-of-life careadministrative reportingcare coordination

Billing Code Overview

HCPCS Level II code M1481 indicates patients who are receiving hospice or palliative care or who died during the measurement period. This code is used to identify a population of patients with serious, life-limiting illness for the purposes of quality measurement and administrative reporting.

Service Type: Hospice and palliative care services
Typical Site of Service: Hospice facilities, inpatient palliative care units, nursing facilities, and home hospice settings

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult with advanced, progressive illness—such as metastatic cancer, end-stage chronic obstructive pulmonary disease, advanced heart failure, or progressive neurodegenerative disease—who has been referred to hospice or receiving palliative care services during the measurement period. The patient may be enrolled in a hospice program where the interdisciplinary hospice team (physician, nurse, social worker, chaplain, hospice aide) provides comfort-focused care in the home, nursing facility, or inpatient hospice unit. Care activities include symptom management visits, goals-of-care discussions, advance care planning, bereavement services for family, coordination of medications and durable medical equipment, and documentation of hospice eligibility and election.

Clinical workflow begins with a hospice referral and eligibility determination by a hospice physician or qualified practitioner. The team conducts an initial assessment, documents terminal prognosis and election of hospice benefits, and initiates a plan of care centered on comfort rather than curative intent. Ongoing visits by hospice nurses and aides occur at intervals based on patient needs, with periodic physician or nurse practitioner oversight. If the patient dies during the measurement period, the hospice documents the date and provides post-death bereavement outreach. Throughout, the medical record captures hospice enrollment, visits, interdisciplinary notes, advance directives, and death or continued palliative enrollment as applicable.

Coding Specifications

Modifier	Description	When to Use
`GT`

HCPCS Level II M1312: Patient Not Screened for Tobacco Use

HCPCS-M1173-TD-TDAP-IMMUNIZATION-GAP

HCPCS M1173: Td/Tdap Immunization Gap Identified

HCPCS-M1316-CURRENT-TOBACCO-NON-USER

HCPCS Level II M1316: Current Tobacco Non-User

HCPCS-M1353-SUICIDE-SAFETY-PLAN-NOT-COMPLETED

HCPCS Level II M1353: Suicide Safety Plan Not Completed

HCPCS-M1328-ACUTE-VITREOUS-HEMORRHAGE-EVALUATION

HCPCS Level II M1328: Acute Vitreous Hemorrhage Evaluation

HCPCS-M1432-TELEHEALTH-ENCOUNTER

HCPCS M1432: Telehealth Encounter

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

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

HCPCS-M1267-KIDNEY-TRANSPLANT-WAITLIST-INACTIVE-STATUS

HCPCS Level II M1267: Kidney/Kidney-Pancreas Transplant Waitlist Inactive Status

HCPCS-M1195-SURGICAL-PATHOLOGY-REPORT-MMR-MSI-TESTING-NOT-STATED

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

HCPCS-M1325-NOT-SEEN-CLINICIAN-DOCUMENTED-MEDICAL-REASONS

HCPCS Level II M1325: Clinician-Documented Patient Not Seen for Ophthalmic Reasons

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Taxonomy Code	Specialty	Notes
`207P00000X`	Hospice and Palliative Medicine	Primary specialty providing hospice/palliative care services and overseeing eligibility and symptom management.
`207Q00000X`	Family Medicine	Common provider specialty participating in hospice/palliative care, often managing routine visits and certifications.
`208D00000X`	Internal Medicine	Hospital- or clinic-based internists who provide palliative consultations and ongoing symptom control for hospice patients.
`208000000X`	Emergency Medicine	Provides urgent evaluations or transitions to hospice from acute care settings; documents hospice referral when applicable.
`363L00000X`	Nursing Service	Registered nurses who perform home visits, symptom assessment, and nursing care planning within hospice programs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C80.1`	Malignant (primary) neoplasm, unspecified	Advanced malignancy with no curative options is a common reason for hospice enrollment and palliative care focus on symptom relief.
`J96.00`	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	Respiratory failure in chronic lung disease may trigger transition to palliative goals and hospice eligibility discussions.
`I50.9`	Heart failure, unspecified	Advanced heart failure refractory to disease-directed therapy is frequently associated with hospice care needs.
`G30.9`	Alzheimer disease, unspecified	Progressive neurodegenerative disease with advanced functional decline often leads to palliative or hospice services.
`N18.6`	End stage renal disease	End-stage organ failure with limited prognosis may be managed with hospice-focused comfort care when disease-directed therapies are limited.
`R99`	Ill-defined and unknown cause of mortality	Used in documentation contexts around death when a more specific cause is not available at time of reporting.
`Z51.5`	Encounter for palliative care	Administrative code used to indicate the patient is receiving palliative care services during the encounter, aligning with hospice documentation.
`Z51.0`	Encounter for antineoplastic radiation therapy	Included when palliative radiation is part of symptom control prior to or during transitions to hospice care.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99497`	Advance care planning including the explanation and discussion of advance directives, by the physician or other qualified health care professional; first 30 minutes, face-to-face	Often performed as part of palliative care encounters or prior to hospice enrollment to document goals of care and directives.
`99498`	Advance care planning; each additional 30 minutes (List separately in addition to code for primary service)	Used when advance care planning requires additional time beyond the initial 30 minutes during palliative care visits.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Commonly billed for outpatient palliative follow-up visits addressing symptom management and care coordination prior to or during hospice eligibility.
`99307`	Skilled nursing facility or nursing facility care, subsequent nursing facility care, per day, typically 10 minutes	Used for ongoing physician or qualified practitioner visits in a nursing facility for patients receiving hospice or palliative services.
`99324`	Domiciliary, rest home, or custodial care services, initial visit for new patient	Used when initial palliative or hospice assessments are performed in a residential or custodial setting as part of enrollment workflow.

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