Summary & Overview
HCPCS M1487: Hospice Patient in Year Before or During Evaluation
HCPCS Level II code M1487 denotes that a patient was in hospice care in the year before or during the reporting or evaluation period. This status code is important for documenting end-of-life care exposure, coordinating care plans, and informing quality measurement and risk adjustment processes at a national level. Accurate capture of hospice status affects clinical records, care transitions, and some population health assessments.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, the clinical contexts where it is applied, and the typical sites of service. The publication outlines what to expect regarding benchmarks, performance measurement implications, and relevant policy considerations for national reporting of hospice-related patient status.
Where input data is incomplete, the document states that specific fields are not available in the input. The content focuses on the code’s clinical meaning and administrative use rather than reimbursement guidance or provider actions.
Billing Code Overview
HCPCS Level II code M1487 indicates patients in hospice in the year before or during the period of evaluation. This code documents a clinical status related to hospice care and is used to capture whether a patient received hospice services within the specified timeframe.
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Service type: Hospice-related patient status assessment
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Typical site of service: Hospice facility or any clinical setting where hospice status is recorded, including inpatient hospice units, home hospice, and outpatient evaluation settings
Data not available in the input for modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult patient who has been enrolled in hospice care either in the year prior to or during the period of evaluation. The patient commonly has a terminal diagnosis such as advanced metastatic cancer, end-stage heart failure, end-stage chronic obstructive pulmonary disease, or progressive neurodegenerative disease and is receiving hospice services focused on comfort and symptom management rather than curative therapy. The clinical workflow for encounters related to M1487 generally includes: a hospice interdisciplinary team assessment (nursing, physician, social work, chaplain) documenting hospice eligibility and goals of care; periodic visits to assess pain, dyspnea, delirium, or other symptoms; coordination of medications and durable medical equipment; and communication with the patient and family regarding prognosis and advanced care planning. Documentation typically includes hospice admission note, ongoing progress notes, medication reconciliation, symptom assessments, and collaboration with the primary hospice physician for plan of care updates. Services coded to M1487 are used to identify patients who are in hospice during the measurement or evaluation period and support quality reporting and care management activities.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
GT | Via interactive audio and video telecommunication system |