HCPCS M1167: In hospice or using hospice services

The primary purpose of M1167 is to identify patients who are in hospice or receiving hospice services during a specific quality measure's measurement period. This allows for their exclusion from the denominator of certain quality measures where the clinical actions being measured may not be appropriate for a patient at the end of life.

The use of M1167 is determined by the specifications of the quality measure you are reporting. You must review the detailed documentation for each quality measure to understand its denominator criteria and exclusions.

If you do not report M1167 for an eligible patient, that patient may be included in the denominator of a quality measure for which they should have been excluded. This could negatively impact your performance rate for that measure, potentially leading to a lower quality score and a negative payment adjustment in programs like MIPS.