M1486 HCPCS SNF Admission Reimbursement | OpenPayer

Summary & Overview

HCPCS M1486: SNF Admission During Evaluation Period

HCPCS Level II code M1486 denotes patients admitted to a skilled nursing facility (SNF) during the period of evaluation. The code captures the clinical and billing context of SNF admissions and is used in claims to identify when a patient’s admission status to a SNF is relevant to an evaluation period. Nationally, accurate use of this code affects care coordination, utilization tracking, and payment processing across post-acute care settings.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical context, the typical site of service, and which payers commonly encounter this code on claims. The publication also provides benchmarks and policy-relevant context where available, plus guidance on how this code aligns with SNF service reporting and evaluation workflows.

This summary aims to help billing managers, compliance officers, and policy analysts understand the role of M1486 in post-acute care claims and reporting. Data not available in the input for specific modifiers, ICD-10 mappings, associated taxonomies, and related billing lines is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1486HCPCS Level IIskilled nursing facilitySNF admissionpost-acute carebilling codeclaims reportingcare coordination

Billing Code Overview

HCPCS Level II code M1486 indicates patients admitted to a skilled nursing facility (SNF) during the period of evaluation. This code represents the service context of patient admissions to a SNF captured during an evaluation period.

Service type: SNF admission-related evaluation
Typical site of service: Skilled Nursing Facility (SNF)

Data not available in the input for modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.

Clinical & Coding Specifications

Clinical Context

A patient is admitted to a skilled nursing facility (SNF) for post-acute care following an inpatient hospital stay for deconditioning after a fall with soft-tissue injury and chronic heart failure. On admission the SNF interdisciplinary team (physician or nurse practitioner, registered nurse, physical therapist, occupational therapist, social worker) performs an evaluation including medication reconciliation, assessment of functional status, wound checks, and a plan of care to address mobility, activities of daily living, and therapy needs. The evaluation period covers the initial assessment and ongoing daily skilled nursing or therapy visits during the first days of SNF stay to determine the level of care, need for continued skilled services, and readiness for discharge or transition of care. Documentation typically includes the admitting history and physical, SNF admission note, therapy evaluation notes, nursing assessment, medication list, and daily progress notes that support the billing code M1486 for patients admitted to a skilled nursing facility during the period of evaluation.

Coding Specifications

Modifier	Description	When to Use
`24`	Unrelated Evaluation and Management (E/M) service during a postoperative period	Use when an unrelated E/M service is provided during a global postoperative period while patient is in the SNF.

HCPCS M1213: Spirometry Assessment, No Prior Confirmed Obstruction

HCPCS-M1485-HCV-NO-SUSTAINED-VIROLOGICAL-RESPONSE

HCPCS M1485: HCV No Sustained Virological Response

HCPCS-M1210-HIGH-RISK-MEDICATION-ORDERS-NOT-ORDERED

HCPCS M1210: At Least Two High-Risk Medication Orders Not Ordered

HCPCS-LEVEL-II-M1356-PATIENTS-WHO-DIED-DURING-MEASUREMENT-PERIOD

HCPCS Level II M1356: Patients Who Died During the Measurement Period

HCPCS-M1244-PATIENT-PERCEIVED-PROVIDER-BEST-INTERESTS

HCPCS M1244: Patient-Reported Provider Best-Interest Response

HCPCS-M1180-IMMUNE-CHECKPOINT-INHIBITOR-THERAPY-MONITORING

HCPCS M1180: Patients on Immune Checkpoint Inhibitor Therapy

HCPCS-M1193-MMR-MSI-PATHOLOGY-REPORT-RECOMMENDATION-TESTING

HCPCS M1193: Surgical Pathology Report for MMR/MSI Testing

HCPCS-M1229-HCV-VIREMIA-REFERRAL-TO-HCV-CLINICIAN

HCPCS Level II M1229: Referral for HCV Viremia to HCV Clinician

HCPCS-M1328-ACUTE-VITREOUS-HEMORRHAGE-EVALUATION

HCPCS Level II M1328: Acute Vitreous Hemorrhage Evaluation

HCPCS-M1147-ONGOING-CARE-DISCONTINUED-DUE-TO-HOSPITALIZATION-OR-SURGERY

HCPCS M1147: Ongoing Care Discontinued Due to Hospitalization or Surgery

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Taxonomy Code	Specialty	Notes
`183500000X`	Physical Medicine & Rehabilitation Physician	Often directs functional assessments and coordinates post-acute plans in SNF admissions.
`367500000X`	Geriatric Medicine	Commonly provides comprehensive admission evaluations for older adults in SNF.
`163W00000X`	Internal Medicine	Hospitalists or SNF attending physicians performing medical oversight and admissions.
`261QP2300X`	Physical Therapist	Performs skilled therapy evaluations and documents progress during SNF evaluation period.
`261QA0501X`	Occupational Therapist	Conducts ADL and adaptive equipment assessments as part of the SNF admission evaluation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z74.01`	Bed confinement status	Relevant for SNF admissions for patients requiring prolonged bed rest or skilled nursing supervision.
`Z74.09`	Other reduced mobility	Applies when decreased mobility necessitates SNF-level rehabilitation and nursing services.
`Z47.89`	Encounter for other orthopedic aftercare	Relevant if the SNF admission follows orthopedic procedures requiring post-acute skilled care.
`I50.9`	Heart failure, unspecified	Common comorbidity prompting skilled nursing oversight and monitoring during post-acute care.
`M54.5`	Low back pain	Common functional impairment contributing to need for SNF admission and therapy services.
`S72.001A`	Fracture of unspecified femur, initial encounter for closed fracture	Example of an acute injury leading to SNF admission for rehabilitation and skilled nursing.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99304`	Initial nursing facility care, per day, for the evaluation and management of a patient, typically 30 minutes	Used for the initial comprehensive E/M at SNF admission when the provider directly evaluates the patient on the day of admission.
`99305`	Initial nursing facility care, per day, for the evaluation and management of a patient, typically 40 minutes	Billed when initial SNF admission evaluation requires moderate complexity and longer face-to-face time.
`99306`	Initial nursing facility care, per day, for the evaluation and management of a patient, typically 55 minutes	Used for the most complex initial SNF admission evaluations with higher medical decision-making.
`92610`	Evaluation of oral and pharyngeal swallowing function	Performed when dysphagia is identified on SNF admission and requires instrumental or clinical swallow evaluation.
`97161`	Physical therapy evaluation - low complexity	Performed by physical therapy during SNF admission as part of the therapy plan of care.
`97162`	Physical therapy evaluation - moderate complexity	Used when therapy assessment during SNF admission documents moderate complexity and impairments.

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