HCPCS M1059 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Screening Procedures Performance Assessment |
| Complexity Level | Low |
National average reimbursement for HCPCS M1059 by major payers:
$70.12
$N/A
$49.42
$N/A
HCPCS M1059 vs. Other Performance Assessment Codes
The HCPCS M1059 code is part of the Screening Procedures services used for Performance Assessment. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS M1059 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| M1058-HCPCS | Low | Patient was a permanent nursing home resident at any time during the performance period |
| M1059-HCPCS | Low | Patient was in hospice or receiving palliative care at any time during the performance period |
| M1060-HCPCS | Low | Patient died prior to the end of the performance period |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS M1059. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the M1059 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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