PayerPrice
Data Platform
Who We Serve
Use Cases
More
Check Local Rates

HCPCS M1059 Fee Schedule

Last Verified: September 2026

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 FactDetail
Service Type

Screening Procedures

Performance Assessment

Complexity LevelLow

National average reimbursement for HCPCS M1059 by major payers:

bcbs

$70.12

uhc

$N/A

aetna

$49.42

cigna

$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.

CodeComplexityDescription
M1058-HCPCSLow
Patient was a permanent nursing home resident at any time during the performance period
M1059-HCPCSLow
Patient was in hospice or receiving palliative care at any time during the performance period
M1060-HCPCSLow
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.

FREE SAMPLE MARKET COMPARISON

Let's review your payer contracts side-by-side with the market.

Bring your top codes (like HCPCS M1059) and we'll show you how you compare in 15 minutes or less.