HCPCS Codes - Medical Procedures, Supplies & DME Codes - m1 Codes
HCPCS Procedure, Supply & DME (Durable Medical Equipment) Codes ("m1" Codes):- M1000 Pain screened as moderate to severe HCPCS Code Code
- M1001 Plan of care to address moderate to severe pain documented on or before the date of the second visit with a clinician HCPCS Code Code
- M1002 Plan of care for moderate to severe pain not documented on or before the date of the second visit with a clinician, reason not given HCPCS Code Code
- M1003 Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic disease modifying anti-rheumatic Code
- M1004 Documentation of medical reason for not screening for tb or interpreting results (i.e., patient positive for tb and documentation of past treatm Code
- M1005 Tb screening not performed or results not interpreted, reason not given HCPCS Code Code
- M1006 Disease activity not assessed, reason not given HCPCS Code Code
- M1007 >=50% of total number of a patient's outpatient ra encounters assessed HCPCS Code Code
- M1008 <50% of total number of a patient's outpatient ra encounters assessed HCPCS Code Code
- M1009 Patient treatment and final evaluation complete HCPCS Code Code
- M1010 Patient treatment and final evaluation complete HCPCS Code Code
- M1011 Patient treatment and final evaluation complete HCPCS Code Code
- M1012 Patient treatment and final evaluation complete HCPCS Code Code
- M1013 Patient treatment and final evaluation complete HCPCS Code Code
- M1014 Patient treatment and final evaluation complete HCPCS Code Code
- M1015 Patient treatment and final evaluation complete HCPCS Code Code
- M1016 Female patients unable to bear children HCPCS Code Code
- M1017 Patient admitted to palliative care services HCPCS Code Code
- M1018 Patients with an active diagnosis or history of cancer (except basal cell and squamous cell skin carcinoma), patients who are heavy tobacco smok Code
- M1019 Adolescent patients 12 to 17 years of age with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve Code
- M1020 Adolescent patients 12 to 17 years of age with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a t Code
- M1021 Patient had only urgent care visits during the performance period HCPCS Code Code
- M1022 Patients who were in hospice at any time during the performance period HCPCS Code Code
- M1023 Adolescent patients 12 to 17 years of age with major depression or dysthymia who reached remission at six months as demonstrated by a six month Code
- M1024 Adolescent patients 12 to 17 years of age with major depression or dysthymia who did not reach remission at six months as demonstrated by a six Code
- M1025 Patients who were in hospice at any time during the performance period HCPCS Code Code
- M1026 Patients who were in hospice at any time during the performance period HCPCS Code Code
- M1027 Imaging of the head (ct or mri) was obtained HCPCS Code Code
- M1028 Documentation of patients with primary headache diagnosis and imaging other than ct or mri obtained HCPCS Code Code
- M1029 Imaging of the head (ct or mri) was not obtained, reason not given HCPCS Code Code
- M1030 Patients with clinical indications for imaging of the head HCPCS Code Code
- M1031 Patients with no clinical indications for imaging of the head HCPCS Code Code
- M1032 Adults currently taking pharmacotherapy for oud HCPCS Code Code
- M1033 Pharmacotherapy for oud initiated after june 30th of performance period HCPCS Code Code
- M1034 Adults who have at least 180 days of continuous pharmacotherapy with a medication prescribed for oud without a gap of more than seven days HCPCS Code
- M1035 Adults who are deliberately phased out of medication assisted treatment (mat) prior to 180 days of continuous treatment HCPCS Code Code
- M1036 Adults who have not had at least 180 days of continuous pharmacotherapy with a medication prescribed for oud without a gap of more than seven da Code
- M1037 Patients with a diagnosis of lumbar spine region cancer at the time of the procedure HCPCS Code Code
- M1038 Patients with a diagnosis of lumbar spine region fracture at the time of the procedure HCPCS Code Code
- M1039 Patients with a diagnosis of lumbar spine region infection at the time of the procedure HCPCS Code Code
- M1040 Patients with a diagnosis of lumbar idiopathic or congenital scoliosis HCPCS Code Code
- M1041 Patient had cancer, fracture or infection related to the lumbar spine or patient had idiopathic or congenital scoliosis HCPCS Code Code
- M1042 Functional status measurement with score was obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome tool w Code
- M1043 Functional status measurement with score was not obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome to Code
- M1044 Functional status was measured by the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperativ Code
- M1045 Functional status measurement with score was obtained utilizing the oxford knee score (oks) patient reported outcome tool within three months pr Code
- M1046 Functional status measurement with score was not obtained utilizing the oxford knee score (oks) patient reported outcome tool within three month Code
- M1047 Functional status was measured by the oxford knee score (oks) patient reported outcome tool within three months preoperatively and at one year ( Code
- M1048 Functional status measurement with score was obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome tool w Code
- M1049 Functional status measurement with score was not obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome to Code
- M1050 Functional status was measured by the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperativ Code
- M1051 Patient had cancer, fracture or infection related to the lumbar spine or patient had idiopathic or congenital scoliosis HCPCS Code Code
- M1052 Leg pain was not measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively H Code
- M1053 Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively HCPCS Code
- M1054 Patient had only urgent care visits during the performance period HCPCS Code Code
- M1055 Aspirin or another antiplatelet therapy used HCPCS Code Code
- M1056 Prescribed anticoagulant medication during the performance period, history of gi bleeding, history of intracranial bleeding, bleeding disorder a Code
- M1057 Aspirin or another antiplatelet therapy not used, reason not given HCPCS Code Code
- M1058 Patient was a permanent nursing home resident at any time during the performance period HCPCS Code Code
- M1059 Patient was in hospice or receiving palliative care at any time during the performance period HCPCS Code Code
- M1060 Patient died prior to the end of the performance period HCPCS Code Code
- M1061 Patient pregnancy HCPCS Code Code
- M1062 Patient immunocompromised HCPCS Code Code
- M1063 Patients receiving high doses of immunosuppressive therapy HCPCS Code Code
- M1064 Shingrix vaccine documented as administered or previously received HCPCS Code Code
- M1065 Shingrix vaccine was not administered for reasons documented by clinician (e.g. patient administered vaccine other than shingrix, patient allerg Code
- M1066 Shingrix vaccine not documented as administered, reason not given HCPCS Code Code
- M1067 Hospice services for patient provided any time during the measurement period HCPCS Code Code
- M1068 Adults who are not ambulatory HCPCS Code Code
- M1069 Patient screened for future fall risk HCPCS Code Code
- M1070 Patient not screened for future fall risk, reason not given HCPCS Code Code
- M1071 Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminotomy HCPCS Code Code
- M1106 The start of an episode of care documented in the medical record HCPCS Code Code
- M1107 Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time bef Code
- M1108 Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only) Code
- M1109 Ongoing care not indicated, patient discharged after only 1-2 visits due to specific medical events, documented in the medical record that make Code
- M1110 Ongoing care not indicated, patient self-discharged early and seen only 1-2 visits (e.g., financial or insurance reasons, transportation problem Code
- M1111 The start of an episode of care documented in the medical record HCPCS Code Code
- M1112 Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time bef Code
- M1113 Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only) Code
- M1114 Ongoing care not indicated, patient discharged after only 1-2 visits due to specific medical events, documented in the medical record that make Code
- M1115 Ongoing care not indicated, patient self-discharged early and seen only 1-2 visits (e.g., financial or insurance reasons, transportation problem Code
- M1116 The start of an episode of care documented in the medical record HCPCS Code Code
- M1117 Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time bef Code
- M1118 Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only) Code
- M1119 Ongoing care not indicated, patient discharged after only 1-2 visits due to specific medical events, documented in the medical record that make Code
- M1120 Ongoing care not indicated, patient self-discharged early and seen only 1-2 visits (e.g., financial or insurance reasons, transportation problem Code
- M1121 The start of an episode of care documented in the medical record HCPCS Code Code
- M1122 Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time bef Code
- M1123 Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only) Code
- M1124 Ongoing care not indicated, patient discharged after only 1-2 visits due to specific medical events, documented in the medical record that make Code
- M1125 Ongoing care not indicated, patient self-discharged early and seen only 1-2 visits (e.g., financial or insurance reasons, transportation problem Code
- M1126 The start of an episode of care documented in the medical record HCPCS Code Code
- M1127 Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time bef Code
- M1128 Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only) Code
- M1129 Ongoing care not indicated, patient discharged after only 1-2 visits due to specific medical events, documented in the medical record that make Code
- M1130 Ongoing care not indicated, patient self-discharged early and seen only 1-2 visits (e.g., financial or insurance reasons, transportation problem Code
- M1131 Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time bef Code
- M1132 Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only) Code
- M1133 Ongoing care not indicated, patient discharged after only 1-2 visits due to specific medical events, documented in the medical record that make Code
- M1134 Ongoing care not indicated, patient self-discharged early and seen only 1-2 visits (e.g., financial or insurance reasons, transportation problem Code
- M1135 The start of an episode of care documented in the medical record HCPCS Code Code
- M1136 The start of an episode of care documented in the medical record HCPCS Code Code
- M1137 Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time bef Code
- M1138 Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only) Code
- M1139 Ongoing care not indicated, patient self-discharged early and seen only 1-2 visits (e.g., financial or insurance reasons, transportation problem Code
- M1140 Ongoing care not indicated, patient discharged after only 1-2 visits due to specific medical events, documented in the medical record that make Code
- M1141 Functional status was not measured by the oxford knee score (oks) at one year (9 to 15 months) postoperatively HCPCS Code Code
- M1142 Emergent cases HCPCS Code Code
- M1143 Initiated episode of rehabilitation therapy, medical, or chiropractic care for neck impairment HCPCS Code Code
- M1144 Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only H Code
- M1145 Most favored nation (mfn) model drug add-on amount, per dose, (do not bill with line items that have the jw modifier) HCPCS Code Code
- M1146 Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation Code
- M1147 Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, Code
- M1148 Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason un Code
- M1149 Patient unable to complete the neck fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or lan Code
- M1150 Left ventricular ejection fraction (lvef) less than or equal to 40% or documentation of moderately or severely depressed left ventricular systol Code
- M1151 Patients with a history of heart transplant or with a left ventricular assist device (lvad) HCPCS Code Code
- M1152 Patients with a history of heart transplant or with a left ventricular assist device (lvad) HCPCS Code Code
- M1153 Patient with diagnosis of osteoporosis on date of encounter HCPCS Code Code
- M1154 Hospice services provided to patient any time during the measurement period HCPCS Code Code
- M1155 Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period HCPCS Code Code
- M1156 Patient received active chemotherapy any time during the measurement period HCPCS Code Code
- M1157 Patient received bone marrow transplant any time during the measurement period HCPCS Code Code
- M1158 Patient had history of immunocompromising conditions prior to or during the measurement period HCPCS Code Code
- M1159 Hospice services provided to patient any time during the measurement period HCPCS Code Code
- M1160 Patient had anaphylaxis due to the meningococcal vaccine any time on or before the patient's 13th birthday HCPCS Code Code
- M1161 Patient had anaphylaxis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday HCPCS Code Code
- M1162 Patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday HCPCS Code Code
- M1163 Patient had anaphylaxis due to the hpv vaccine any time on or before the patient's 13th birthday HCPCS Code Code
- M1164 Patients with dementia any time during the patient's history through the end of the measurement period HCPCS Code Code
- M1165 Patients who use hospice services any time during the measurement period HCPCS Code Code
- M1166 Pathology report for tissue specimens produced from wide local excisions or re-excisions HCPCS Code Code
- M1167 In hospice or using hospice services during the measurement period HCPCS Code Code
- M1168 Patient received an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period HCP Code
- M1169 Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine) HCPCS Code Code
- M1170 Patient did not receive an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement per Code
- M1171 Patient received at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period HCP Code
- M1172 Documentation of medical reason(s) for not administering td or tdap vaccine (e.g., prior anaphylaxis due to the td or tdap vaccine or history of Code
- M1173 Patient did not receive at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement per Code
- M1174 Patient received at least one dose of the herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 days apa Code
- M1175 Documentation of medical reason(s) for not administering zoster vaccine (e.g., prior anaphylaxis due to the zoster vaccine) HCPCS Code Code
- M1176 Patient did not receive at least one dose of the herpes zoster live vaccine or two doses of the herpes zoster recombinant vaccine (at least 28 d Code
- M1177 Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 60th birthday and before the end of the measurement peri Code
- M1178 Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., prior anaphylaxis due to the pneumococcal vaccine) HCPCS Co Code
- M1179 Patient did not receive any pneumococcal conjugate or polysaccharide vaccine, on or after their 60th birthday and before or during measurement p Code
- M1180 Patients on immune checkpoint inhibitor therapy HCPCS Code Code
- M1181 Grade 2 or above diarrhea and/or grade 2 or above colitis HCPCS Code Code
- M1182 Patients not eligible due to pre-existing inflammatory bowel disease (ibd) (e.g., ulcerative colitis, crohn's disease) HCPCS Code Code
- M1183 Documentation of immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered HCPCS Code Code
- M1184 Documentation of medical reason(s) for not prescribing or administering corticosteroid or immunosuppressant treatment (e.g., allergy, intoleranc Code
- M1185 Documentation of immune checkpoint inhibitor therapy not held and/or corticosteroids or immunosuppressants prescribed or administered was not pe Code
- M1186 Patients who have an order for or are receiving hospice or palliative care HCPCS Code Code
- M1187 Patients with a diagnosis of end stage renal disease (esrd) HCPCS Code Code
- M1188 Patients with a diagnosis of chronic kidney disease (ckd) stage 5 HCPCS Code Code
- M1189 Documentation of a kidney health evaluation defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) Code
- M1190 Documentation of a kidney health evaluation was not performed or defined by an estimated glomerular filtration rate (egfr) and urine albumin-cre Code
- M1191 Hospice services provided to patient any time during the measurement period HCPCS Code Code
- M1192 Patients with an existing diagnosis of squamous cell carcinoma of the esophagus HCPCS Code Code
- M1193 Surgical pathology reports that contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-bas Code
- M1194 Documentation of medical reason(s) surgical pathology reports did not contain impression or conclusion of or recommendation for testing of mmr b Code
- M1195 Surgical pathology reports that do not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by Code
- M1196 Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4 HCPCS Code
- M1197 Itch severity assessment score is reduced by 2 or more points from the initial (index) assessment score to the follow-up visit score HCPCS Code Code
- M1198 Itch severity assessment score was not reduced by at least 2 points from initial (index) score to the follow-up visit score or assessment was no Code
- M1199 Patients receiving rrt HCPCS Code Code
- M1200 Ace inhibitor (ace-i) or arb therapy prescribed during the measurement period HCPCS Code Code
- M1201 Documentation of medical reason(s) for not prescribing ace inhibitor (ace-i) or arb therapy during the measurement period (e.g., pregnancy, hist Code
- M1202 Documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, othe Code
- M1203 Ace inhibitor or arb therapy not prescribed during the measurement period, reason not given HCPCS Code Code
- M1204 Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4 HCPCS Code
- M1205 Itch severity assessment score is reduced by 2 or more points from the initial (index) assessment score to the follow-up visit score HCPCS Code Code
- M1206 Itch severity assessment score was not reduced by at least 2 points from initial (index) score to the follow-up visit score or assessment was no Code
- M1207 Number of patients screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety HCPCS Code
- M1208 Number of patients not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety H Code
- M1209 At least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses HCPCS Code Code
- M1210 At least two orders for high-risk medications from the same drug class, (table 4), not ordered HCPCS Code Code
- M1211 Most recent hemoglobin a1c level > 9.0% HCPCS Code Code
- M1212 Hemoglobin a1c level is missing, or was not performed during the measurement period (12 months) HCPCS Code Code
- M1213 No history of spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) and present spirometry is >= 70% HCPCS Code Code
- M1214 Spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and reviewed HCPCS Code Code
- M1215 Documentation of medical reason(s) for not documenting and reviewing spirometry results (e.g., patients with dementia or tracheostomy) HCPCS Cod Code
- M1216 No spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and/or no spirometry performed with results documented duri Code
- M1217 Documentation of system reason(s) for not documenting and reviewing spirometry results (e.g., spirometry equipment not available at the time of Code
- M1218 Patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing) HCPCS Code Code
- M1219 Anaphylaxis due to the vaccine on or before the date of the encounter HCPCS Code Code
- M1220 Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and Code
- M1221 Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and Code
- M1222 Glaucoma plan of care not documented, reason not otherwise specified HCPCS Code Code
- M1223 Glaucoma plan of care documented HCPCS Code Code
- M1224 Intraocular pressure (iop) reduced by a value less than 20% from the pre-intervention level HCPCS Code Code
- M1225 Intraocular pressure (iop) reduced by a value of greater than or equal to 20% from the pre-intervention level HCPCS Code Code
- M1226 Iop measurement not documented, reason not otherwise specified HCPCS Code Code
- M1227 Evidence-based therapy was prescribed HCPCS Code Code
- M1228 Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, has hcv treatment initiated within Code
- M1229 Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, is referred within 1 month of the r Code
- M1230 Patient has a reactive hcv antibody test and does not have a follow up hcv viral test, or patient has a reactive hcv antibody test and has a fol Code
- M1231 Patient receives hcv antibody test with nonreactive result HCPCS Code Code
- M1232 Patient receives hcv antibody test with reactive result HCPCS Code Code
- M1233 Patient does not receive hcv antibody test or patient does receive hcv antibody test but results not documented, reason not given HCPCS Code Code
- M1234 Patient has a reactive hcv antibody test, and has a follow up hcv viral test that does not detect hcv viremia HCPCS Code Code
- M1235 Documentation or patient report of hcv antibody test or hcv rna test which occurred prior to the performance period HCPCS Code Code
- M1236 Baseline mrs > 2 HCPCS Code Code
- M1237 Patient reason for not screening for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety Code
- M1238 Documentation that administration of second recombinant zoster vaccine could not occur during the performance period due to the recommended 2-6 Code
- M1239 Patient did not respond to the question of patient felt heard and understood by this provider and team HCPCS Code Code
- M1240 Patient did not respond to the question of patient felt this provider and team put my best interests first when making recommendations about my Code
- M1241 Patient did not respond to the question of patient felt this provider and team saw me as a person, not just someone with a medical problem HCPCS Code
- M1242 Patient did not respond to the question of patient felt this provider and team understood what is important to me in my life HCPCS Code Code
- M1243 Patient provided a response other than completely true"" for the question of patient felt heard and understood by this provider and team" HCPCS Code
- M1244 Patient provided a response other than completely true"" for the question of patient felt this provider and team put my best interests first whe Code
- M1245 Patient provided a response other than completely true"" for the question of patient felt this provider and team saw me as a person, not just so Code
- M1246 Patient provided a response other than completely true"" for the question of patient felt this provider and team understood what is important to Code
- M1247 Patient responded completely true"" for the question of patient felt this provider and team put my best interests first when making recommendati Code
- M1248 Patient responded completely true"" for the question of patient felt this provider and team saw me as a person, not just someone with a medical Code
- M1249 Patient responded completely true"" for the question of patient felt this provider and team understood what is important to me in my life" HCPCS Code
- M1250 Patient responded as completely true"" for the question of patient felt heard and understood by this provider and team" HCPCS Code Code
- M1251 Patients for whom a proxy completed the entire hu survey on their behalf for any reason (no patient involvement) HCPCS Code Code
- M1252 Patients who did not complete at least one of the four patient experience hu survey items and return the hu survey within 60 days of the ambulat Code
- M1253 Patients who respond on the patient experience hu survey that they did not receive care by the listed ambulatory palliative care provider in the Code
- M1254 Patients who were deceased when the hu survey reached them HCPCS Code Code
- M1255 Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not estab Code
- M1256 Prior history of known cvd HCPCS Code Code
- M1257 Cvd risk assessment not performed or incomplete (e.g., cvd risk assessment was not documented), reason not otherwise specified HCPCS Code Code
- M1258 Cvd risk assessment performed, have a documented calculated risk score HCPCS Code Code
- M1259 Patients listed on the kidney-pancreas transplant waitlist or who received a living donor transplant within the first year following initiation Code
- M1260 Patients who were not listed on the kidney-pancreas transplant waitlist or patients who did not receive a living donor transplant within the fir Code
- M1261 Patients that were on the kidney or kidney-pancreas waitlist prior to initiation of dialysis HCPCS Code Code
- M1262 Patients who had a transplant prior to initiation of dialysis HCPCS Code Code
- M1263 Patients in hospice on their initiation of dialysis date or during the month of evaluation HCPCS Code Code
- M1264 Patients age 75 or older on their initiation of dialysis date HCPCS Code Code
- M1265 Cms medical evidence form 2728 for dialysis patients: initial form completed HCPCS Code Code
- M1266 Patients admitted to a skilled nursing facility (snf) HCPCS Code Code
- M1267 Patients not on any kidney or kidney-pancreas transplant waitlist or is not in active status on any kidney or kidney-pancreas transplant waitlis Code
- M1268 Patients on active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period HC Code
- M1269 Receiving esrd mcp dialysis services by the provider on the last day of the reporting month HCPCS Code Code
- M1270 Patients not on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period HCPCS Code Code
- M1271 Patients with dementia at any time prior to or during the month HCPCS Code Code
- M1272 Patients on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period HCPCS Code Code
- M1273 Patients who were admitted to a skilled nursing facility (snf) within one year of dialysis initiation according to the cms-2728 form HCPCS Code Code
- M1274 Patients who were admitted to a skilled nursing facility (snf) during the month of evaluation were excluded from that month HCPCS Code Code
- M1275 Patients determined to be in hospice were excluded from month of evaluation and the remainder of reporting period HCPCS Code Code
- M1276 Bmi documented outside normal parameters, no follow-up plan documented, no reason given HCPCS Code Code
- M1277 Colorectal cancer screening results documented and reviewed HCPCS Code Code
- M1278 Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented HCPCS Code Code
- M1279 Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given HCPCS Code Code
- M1280 Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilate Code
- M1281 Blood pressure reading not documented, reason not given HCPCS Code Code
- M1282 Patient screened for tobacco use and identified as a tobacco non-user HCPCS Code Code
- M1283 Patient screened for tobacco use and identified as a tobacco user HCPCS Code Code
- M1284 Patients age 66 or older in institutional special needs plans (snp) or residing in long term care with pos code 32, 33, 34, 54, or 56 for more t Code
- M1285 Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not other Code
- M1286 Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason HCPCS Code Code
- M1287 Bmi is documented below normal parameters and a follow-up plan is documented HCPCS Code Code
- M1288 Documented reason for not screening or recommending a follow-up for high blood pressure HCPCS Code Code
- M1289 Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to th Code
- M1290 Patient not eligible due to active diagnosis of hypertension HCPCS Code Code
- M1291 Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for de Code
- M1292 Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient en Code
- M1293 Bmi is documented above normal parameters and a follow-up plan is documented HCPCS Code Code
- M1294 Normal blood pressure reading documented, follow-up not required HCPCS Code Code
- M1295 Patients with a diagnosis or past history of total colectomy or colorectal cancer HCPCS Code Code
- M1296 Bmi is documented within normal parameters and no follow-up plan is required HCPCS Code Code
- M1297 Bmi not documented due to medical reason or patient refusal of height or weight measurement HCPCS Code Code
- M1298 Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter HCPCS Code Code
- M1299 Influenza immunization administered or previously received HCPCS Code Code
- M1300 Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient decline Code
- M1301 Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the mea Code
- M1302 Screening, diagnostic, film digital or digital breast tomosynthesis (3d) mammography results documented and reviewed HCPCS Code Code
- M1303 Hospice services provided to patient any time during the measurement period HCPCS Code Code
- M1304 Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measureme Code
- M1305 Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement peri Code
- M1306 Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period HCPCS Code Code
- M1307 Documentation stating the patient has received or is currently receiving palliative or hospice care HCPCS Code Code
- M1308 Influenza immunization was not administered, reason not given HCPCS Code Code
- M1309 Palliative care services provided to patient any time during the measurement period HCPCS Code Code
- M1310 Patient screened for tobacco use and received tobacco cessation intervention during the measurement period or in the six months prior to the mea Code
- M1311 Anaphylaxis due to the vaccine on or before the date of the encounter HCPCS Code Code
- M1312 Patient not screened for tobacco use HCPCS Code Code
- M1313 Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the m Code
- M1314 Bmi not documented and no reason is given HCPCS Code Code
- M1315 Colorectal cancer screening results were not documented and reviewed; reason not otherwise specified HCPCS Code Code
- M1316 Current tobacco non-user HCPCS Code Code
- M1317 Patients who are counseled on connection with a csp and explicitly opt out HCPCS Code Code
- M1318 Patients who did not have documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening or docu Code
- M1319 Patients who had documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening HCPCS Code Code
- M1320 Patients who screened positive for at least 1 of the 5 hrsns HCPCS Code Code
- M1321 Patients who were not seen within 7 weeks following the date of injection for follow up or who did not have a documented iop or no plan of care Code
- M1322 Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with docume Code
- M1323 Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with docume Code
- M1324 Patients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, de Code
- M1325 Patients who were not seen for reasons documented by clinician for patient or medical reasons (e.g., inadequate time for follow-up, patients who Code
- M1326 Patients with a diagnosis of hypotony HCPCS Code Code
- M1327 Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 8 weeks HCPCS Code Code
- M1328 Patients with a diagnosis of acute vitreous hemorrhage HCPCS Code Code
- M1329 Patients with a post-operative encounter of the eye with the acute pvd within 2 weeks before the initial encounter or 8 weeks after initial acut Code
- M1330 Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up) HCPCS Code Code
- M1331 Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 8 weeks from initial exam HCPCS Code Code
- M1332 Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 2 weeks HCPCS Code Code
- M1333 Acute vitreous hemorrhage HCPCS Code Code
- M1334 Patients with a post-operative encounter of the eye with the acute pvd within 2 weeks before the initial encounter or 2 weeks after initial acut Code
- M1335 Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up) HCPCS Code Code
- M1336 Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 2 weeks HCPCS Code Code
- M1337 Acute pvd HCPCS Code Code
- M1338 Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of f Code
- M1339 Patients who had follow-up assessment 30 to 180 days after the index assessment who demonstrated positive improvement or maintenance of function Code
- M1340 Index assessment completed using the 12-item whodas 2.0 or sds during the denominator identification period HCPCS Code Code
- M1341 Patients who did not have a follow-up assessment or did not have an assessment within 30 to 180 days after the index assessment during the perfo Code
- M1342 Patients who died during the performance period HCPCS Code Code
- M1343 Patients who are at pam level 4 at baseline or patients who are flagged with extreme straight line response sets on the pam HCPCS Code Code
- M1344 Patients who did not have a baseline pam score and/or a second score within 6 to 12 month of baseline pam score HCPCS Code Code
- M1345 Patients who had a baseline pam score and a second score within 6 to 12 month of baseline pam score HCPCS Code Code
- M1346 Patients who did not have a net increase in pam score of at least 6 points within a 6 to 12 month period HCPCS Code Code
- M1347 Patients who achieved a net increase in pam score of at least 3 points in a 6 to 12 month period (passing) HCPCS Code Code
- M1348 Patients who achieved a net increase in pam score of at least 6-points in a 6 to 12 month period (excellent) HCPCS Code Code
- M1349 Patients who did not have a net increase in pam score of at least 3 points within 6 to 12 month period HCPCS Code Code
- M1350 Patients who had a completed suicide safety plan initiated, reviewed or updated in collaboration with their clinician (concurrent or within 24 h Code
- M1351 Patients who had a suicide safety plan initiated, reviewed, or updated and reviewed and updated in collaboration with the patient and their clin Code
- M1352 Suicidal ideation and/or behavior symptoms based on the c-ssrs or equivalent assessment HCPCS Code Code
- M1353 Patients who did not have a completed suicide safety plan initiated, reviewed or updated in collaboration with their clinician (concurrent or wi Code
- M1354 Patients who did not have a suicide safety plan initiated, reviewed, or updated or reviewed and updated in collaboration with the patient and th Code
- M1355 Suicide risk based on their clinician's evaluation or a clinician-rated tool HCPCS Code Code
- M1356 Patients who died during the measurement period HCPCS Code Code
- M1357 Patients who had a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment HCPCS Code Code
- M1358 Patients who did not have a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment HCPCS C Code
- M1359 Index assessment during the denominator period when the suicidal ideation and/or behavior symptoms or increased suicide risk by clinician determ Code
- M1360 Suicidal ideation and/or behavior symptoms based on the c-ssrs HCPCS Code Code
- M1361 Suicide risk based on their clinician's evaluation or a clinician-rated tool HCPCS Code Code
- M1362 Patients who died during the measurement period HCPCS Code Code
- M1363 Patients who did not have a follow-up assessment within 120 days of the index assessment HCPCS Code Code
- M1364 Calculated 10-year ascvd risk score of >= 20 percent during the performance period HCPCS Code Code
- M1365 Patient encounter during the performance period with hospice and palliative care specialty code 17 HCPCS Code Code
- M1366 Focusing on women's health mips value pathway HCPCS Code Code
- M1367 Quality care for the treatment of ear, nose, and throat disorders mips value pathway HCPCS Code Code
- M1368 Prevention and treatment of infectious disorders including hepatitis c and hiv mips value pathway HCPCS Code Code
- M1369 Quality care in mental health and substance use disorders mips value pathway HCPCS Code Code
- M1370 Rehabilitative support for musculoskeletal care mips value pathway HCPCS Code Code
Back to list of HCPCS Procedure, Supply & DME Codes
HCPCS Medical Codes & Code Modifiers
(HCPCS is commonly pronounced Hick-Picks.)Each year, in the United States, health care insurers process over 5 billion claims for payment. For Medicare and other health insurance programs to ensure that these claims are processed in an orderly and consistent manner, standardized coding systems are essential. The HCPCS Level II Code Set is one of the standard code sets used for this purpose. The HCPCS is divided into two principal subsystems, referred to as level I and level II of the HCPCS. Level I of the HCPCS is comprised of CPT (Current Procedural Terminology), a numeric coding system maintained by the American Medical Association (AMA). The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. These health care professionals use the CPT to identify services and procedures for which they bill public or private health insurance programs. Decisions regarding the addition, deletion, or revision of CPT codes are made by the AMA. The CPT codes are republished and updated annually by the AMA. Level I of the HCPCS, the CPT codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians.
Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT codes, the level II HCPCS codes were established for submitting claims for these items. The development and use of level II of the HCPCS began in the 1980's. Level II codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits.
In October of 2003, the Secretary of HHS delegated authority under the HIPAA legislation to CMS to maintain and distribute HCPCS Level II Codes. As stated in 42 CFR Sec. 414.40 (a) CMS establishes uniform national definitions of services, codes to represent services, and payment modifiers to the codes. Within CMS there is a CMS HCPCS Workgroup which is an internal workgroup comprised of representatives of the major components of CMS, as well as other consultants from pertinent Federal agencies. Prior to December 31, 2003, Level III HCPCS were developed and used by Medicaid State agencies, Medicare contractors, and private insurers in their specific programs or local areas of jurisdiction. For purposes of Medicare, level III codes were also referred to as local codes. Local codes were established when an insurer preferred that suppliers use a local code to identify a service, for which there is no level I or level II code, rather than use a "miscellaneous or not otherwise classified code." The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required CMS to adopt standards for coding systems that are used for reporting health care transactions. We published, in the Federal Register on August 17, 2000 (65 FR 50312), regulations to implement this part of the HIPAA legislation. These regulations provided for the elimination of level III local codes by October 2002, at which time, the level I and level II code sets could be used. The elimination of local codes was postponed, as a result of section 532(a) of BIPA, which continued the use of local codes through December 31, 2003.
(Source: http://www.cms.hhs.gov/MedHCPCSGenInfo/)
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