HCPCS M Codes | A Guide to Medical Services HCPCS Codes

Welcome to our in-depth guide on HCPCS M Codes, a vital aspect of medical billing and coding. These codes play a pivotal role in accurately documenting and reimbursing for essential medical services. In this guide, we delve into the specifics of M Codes (Medical Services Codes). Additionally, we explore the application of these M Codes and provide a list of M-Codes with detailed descriptions for seamless navigation.

HCPCS M Codes

HCPCS M Codes

Medical Services

Among the HCPCS codes sets, HCPCS Level II codes, specifically the HCPCS M codes, play a significant role in identifying and reporting medical services and procedures. This comprehensive guide aims to provide an in-depth understanding of M codes.

HCPCS M-Codes ListHCPCS M Codes Description
M0001 Advancing cancer care mips value pathways
M0002 Optimal care for kidney health mips value pathways
M0003 Optimal care for patients with episodic neurological conditions mips value pathways
M0004 Supportive care for neurodegenerative conditions mips value pathways
M0005 Value in primary care mips value pathway
M0010 Enhancing oncology model (eom) monthly enhanced oncology services (meos) payment for eom enhanced services
M0064 Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders
M0075 Cellular therapy
M0076 Prolotherapy
M0100 Intragastric hypothermia using gastric freezing
M0201 Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient’s home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient’s home
M0220 Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring
M0221 Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency
M0222 Intravenous injection, bebtelovimab, includes injection and post administration monitoring
M0223 Intravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency
M0239 Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring
M0240 Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses
M0241 Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency, subsequent repeat doses
M0243 Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring
M0244 Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency
M0245 Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring
M0246 Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider based to the hospital during the covid 19 public health emergency
M0247 Intravenous infusion, sotrovimab, includes infusion and post administration monitoring
M0248 Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency
M0249 Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, first dose
M0250 Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, second dose
M0300 Iv chelation therapy (chemical endarterectomy)
M0301 Fabric wrapping of abdominal aneurysm
M1000 Pain screened as moderate to severe
M1001 Plan of care to address moderate to severe pain documented on or before the date of the second visit with a clinician
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
M1003 Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic and/or immune response modifier therapy
M1004 Documentation of medical reason for not screening for tb or interpreting results (i.e., patient positive for tb and documentation of past treatment; patient who has recently completed a course of anti-tb therapy)
M1005 Tb screening not performed or results not interpreted, reason not given
M1006 Disease activity not assessed, reason not given
M1007 >=50% of total number of a patient’s outpatient ra encounters assessed
M1008 <50% of total number of a patient’s outpatient ra encounters assessed
M1009 Discharge/discontinuation of the episode of care documented in the medical record
M1010 Discharge/discontinuation of the episode of care documented in the medical record
M1011 Discharge/discontinuation of the episode of care documented in the medical record
M1012 Discharge/discontinuation of the episode of care documented in the medical record
M1013 Discharge/discontinuation of the episode of care documented in the medical record
M1014 Discharge/discontinuation of the episode of care documented in the medical record
M1015 Discharge/discontinuation of the episode of care documented in the medical record
M1016 Female patients unable to bear children
M1017 Patient admitted to palliative care services
M1018 Patients with an active diagnosis or history of cancer (except basal cell and squamous cell skin carcinoma), patients who are heavy tobacco smokers, lung cancer screening patients
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 month (+/-60 days) phq-9 or phq-9m score of less than 5
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 twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq-9 or phq-9m score was not assessed or is greater than or equal to 5
M1021 Patient had only urgent care visits during the performance period
M1022 Patients who were in hospice at any time during the performance period
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 (+/-60 days) phq-9 or phq-9m score of less than five
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 month (+/-60 days) phq-9 or phq-9m score of less than five. either phq-9 or phq-9m score was not assessed or is greater than or equal to five
M1025 Patients who were in hospice at any time during the performance period
M1026 Patients who were in hospice at any time during the performance period
M1027 Imaging of the head (ct or mri) was obtained
M1028 Documentation of patients with primary headache diagnosis and imaging other than ct or mri obtained
M1029 Imaging of the head (ct or mri) was not obtained, reason not given
M1030 Patients with clinical indications for imaging of the head
M1031 Patients with no clinical indications for imaging of the head
M1032 Adults currently taking pharmacotherapy for oud
M1033 Pharmacotherapy for oud initiated after june 30th of performance period
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
M1035 Adults who are deliberately phased out of medication assisted treatment (mat) prior to 180 days of continuous treatment
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 days
M1037 Patients with a diagnosis of lumbar spine region cancer at the time of the procedure
M1038 Patients with a diagnosis of lumbar spine region fracture at the time of the procedure
M1039 Patients with a diagnosis of lumbar spine region infection at the time of the procedure
M1040 Patients with a diagnosis of lumbar idiopathic or congenital scoliosis
M1041 Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis
M1042 Functional status measurement with score was obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively
M1043 Functional status was not measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively
M1044 Functional status was measured by the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively
M1045 Functional status measured by the oxford knee score (oks) at one year (9 to 15 months) postoperatively was greater than or equal to 37 or knee injury and osteoarthritis outcome score joint replacement (koos, jr.) was greater than or equal to 71
M1046 Functional status measured by the oxford knee score (oks) at one year (9 to 15 months) postoperatively was less than 37 or the knee injury and osteoarthritis outcome score joint replacement (koos, jr.) was less than 71 postoperatively
M1047 Functional status was measured by the oxford knee score (oks) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively
M1048 Functional status measurement with score was obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at three months (6 to 20 weeks) postoperatively
M1049 Functional status was not measured by the oswestry disability index (odi version 2.1a) at three months (6 – 20 weeks) postoperatively
M1050 Functional status was measured by the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at three months (6 to 20 weeks) postoperatively
M1051 Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis
M1052 Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively
M1053 Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively
M1054 Patient had only urgent care visits during the performance period
M1055 Aspirin or another antiplatelet therapy used
M1056 Prescribed anticoagulant medication during the performance period, history of gi bleeding, history of intracranial bleeding, bleeding disorder and specific provider documented reasons: allergy to aspirin or anti-platelets, use of non-steroidal anti-inflammatory agents, drug-drug interaction, uncontrolled hypertension > 180/110 mmhg or gastroesophageal reflux disease
M1057 Aspirin or another antiplatelet therapy not used, reason not given
M1058 Patient was a permanent nursing home resident at any time during the performance period
M1059 Patient was in hospice or receiving palliative care at any time during the performance period
M1060 Patient died prior to the end of the performance period
M1061 Patient pregnancy
M1062 Patient immunocompromised
M1063 Patients receiving high doses of immunosuppressive therapy
M1064 Shingrix vaccine documented as administered or previously received
M1065 Shingrix vaccine was not administered for reasons documented by clinician (e.g. patient administered vaccine other than shingrix, patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)
M1066 Shingrix vaccine not documented as administered, reason not given
M1067 Hospice services for patient provided any time during the measurement period
M1068 Adults who are not ambulatory
M1069 Patient screened for future fall risk
M1070 Patient not screened for future fall risk, reason not given
M1071 Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminotomy
M1106 The start of an episode of care documented in the medical record
M1107 Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson’s diagnosed at any time before or during the episode of care
M1108 Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record
M1109 Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery
M1110 Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)
M1111 The start of an episode of care documented in the medical record
M1112 Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson’s diagnosed at any time before or during the episode of care
M1113 Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record
M1114 Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery
M1115 Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)
M1116 The start of an episode of care documented in the medical record
M1117 Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson’s diagnosed at any time before or during the episode of care
M1118 Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record
M1119 Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery
M1120 Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)
M1121 The start of an episode of care documented in the medical record
M1122 Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson’s diagnosed at any time before or during the episode of care
M1123 Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record
M1124 Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery
M1125 Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)
M1126 The start of an episode of care documented in the medical record
M1127 Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson’s diagnosed at any time before or during the episode of care
M1128 Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record
M1129 Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery
M1130 Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)
M1131 Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson’s diagnosed at any time before or during the episode of care
M1132 Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record
M1133 Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery
M1134 Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)
M1135 The start of an episode of care documented in the medical record
M1136 The start of an episode of care documented in the medical record
M1137 Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson’s diagnosed at any time before or during the episode of care
M1138 Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only)
M1139 Ongoing care not indicated, patient self-discharged early and seen only 1-2 visits (e.g., financial or insurance reasons, transportation problems, or reason unknown)
M1140 Ongoing care not indicated, patient discharged after only 1-2 visits due to specific medical events, documented in the medical record that make the treatment episode impossible such as the patient becomes hospitalized or scheduled for surgery for surgery or hospitalized
M1141 Functional status was not measured by the oxford knee score (oks) or the knee injury and osteoarthritis outcome score joint replacement (koos, jr.) at one year (9 to 15 months) postoperatively
M1142 Emergent cases
M1143 Initiated episode of rehabilitation therapy, medical, or chiropractic care for neck impairment
M1144 Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only
M1145 Most favored nation (mfn) model drug add-on amount, per dose, (do not bill with line items that have the jw modifier)
M1146 Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record
M1147 Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery
M1148 Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)
M1149 Patient unable to complete the neck fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility, and an adequate proxy is not available
M1150 Left ventricular ejection fraction (lvef) less than or equal to 40% or documentation of moderately or severely depressed left ventricular systolic function
M1151 Patients with a history of heart transplant or with a left ventricular assist device (lvad)
M1152 Patients with a history of heart transplant or with a left ventricular assist device (lvad)
M1153 Patient with diagnosis of osteoporosis on date of encounter
M1154 Hospice services provided to patient any time during the measurement period
M1155 Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period
M1156 Patient received active chemotherapy any time during the measurement period   Discontinued
M1157 Patient received bone marrow transplant any time during the measurement period   Discontinued
M1158 Patient had history of immunocompromising conditions prior to or during the measurement period   Discontinued
M1159 Hospice services provided to patient any time during the measurement period
M1160 Patient had anaphylaxis due to the meningococcal vaccine any time on or before the patient’s 13th birthday
M1161 Patient had anaphylaxis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient’s 13th birthday
M1162 Patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient’s 13th birthday
M1163 Patient had anaphylaxis due to the hpv vaccine any time on or before the patient’s 13th birthday
M1164 Patients with dementia any time during the patient’s history through the end of the measurement period
M1165 Patients who use hospice services any time during the measurement period
M1166 Pathology report for tissue specimens produced from wide local excisions or re-excisions
M1167 In hospice or using hospice services during the measurement period
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
M1169 Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine)
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 period
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
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 encephalopathy within seven days after a previous dose of a td-containing vaccine)
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 period
M1174 Patient received at least two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient’s 50th birthday before or during the measurement period
M1175 Documentation of medical reason(s) for not administering zoster vaccine (e.g., prior anaphylaxis due to the zoster vaccine)
M1176 Patient did not receive at least two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient’s 50th birthday before or during the measurement period
M1177 Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 60th birthday and before the end of the measurement period
M1178 Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., prior anaphylaxis due to the pneumococcal vaccine)
M1179 Patient did not receive any pneumococcal conjugate or polysaccharide vaccine, on or after their 60th birthday and before or during measurement period
M1180 Patients on immune checkpoint inhibitor therapy
M1181 Grade 2 or above diarrhea and/or grade 2 or above colitis
M1182 Patients not eligible due to pre-existing inflammatory bowel disease (ibd) (e.g., ulcerative colitis, crohn’s disease)
M1183 Documentation of immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered
M1184 Documentation of medical reason(s) for not prescribing or administering corticosteroid or immunosuppressant treatment (e.g., allergy, intolerance, infectious etiology, pancreatic insufficiency, hyperthyroidism, prior bowel surgical interventions, celiac disease, receiving other medication, awaiting diagnostic workup results for alternative etiologies, other medical reasons/contraindication)
M1185 Documentation of immune checkpoint inhibitor therapy not held and/or corticosteroids or immunosuppressants prescribed or administered was not performed, reason not given
M1186 Patients who have an order for or are receiving hospice or palliative care
M1187 Patients with a diagnosis of end stage renal disease (esrd)
M1188 Patients with a diagnosis of chronic kidney disease (ckd) stage 5
M1189 Documentation of a kidney health evaluation defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) performed
M1190 Documentation of a kidney health evaluation was not performed or defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr)
M1191 Hospice services provided to patient any time during the measurement period
M1192 Patients with an existing diagnosis of squamous cell carcinoma of the esophagus
M1193 Surgical pathology reports that contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both
M1194 Documentation of medical reason(s) surgical pathology reports did not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both tests were not included (e.g., patient will not be treated with checkpoint inhibitor therapy, no residual carcinoma is present in the sample [tissue exhausted or status post neoadjuvant treatment], insufficient tumor for testing)
M1195 Surgical pathology reports that do not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both, reason not given
M1196 Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4
M1197 Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score
M1198 Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter
M1199 Patients receiving rrt
M1200 Ace inhibitor (ace-i) or arb therapy prescribed during the measurement period
M1201 Documentation of medical reason(s) for not prescribing ace inhibitor (ace-i) or arb therapy during the measurement period (e.g., pregnancy, history of angioedema to ace-i, other allergy to ace-i and arb, hyperkalemia or history of hyperkalemia while on ace-i or arb therapy, acute kidney injury due to ace-i or arb therapy), other medical reasons)
M1202 Documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons)
M1203 Ace inhibitor or arb therapy not prescribed during the measurement period, reason not given
M1204 Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4
M1205 Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score
M1206 Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter
M1207 Patient is screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
M1208 Patient is not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
M1209 At least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses
M1210 At least two orders for high-risk medications from the same drug class, (table 4), not ordered
M1211 Most recent hemoglobin a1c level > 9.0%   New
M1212 Hemoglobin a1c level is missing, or was not performed during the measurement period (12 months)   New
M1213 No history of spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) and present spirometry is >= 70%   New
M1214 Spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and reviewed   New
M1215 Documentation of medical reason(s) for not documenting and reviewing spirometry results (e.g., patients with dementia or tracheostomy)   New
M1216 No spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and/or no spirometry performed with results documented during the encounter   New
M1217 Documentation of system reason(s) for not documenting and reviewing spirometry results (e.g., spirometry equipment not available at the time of the encounter)   New
M1218 Patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing)   New
M1219 Anaphylaxis due to the vaccine on or before the date of the encounter   New
M1220 Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; with evidence of retinopathy   New
M1221 Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy   New
M1222 Glaucoma plan of care not documented, reason not otherwise specified   New
M1223 Glaucoma plan of care documented   New
M1224 Intraocular pressure (iop) reduced by a value less than 20% from the pre-intervention level   New
M1225 Intraocular pressure (iop) reduced by a value of greater than or equal to 20% from the pre-intervention level   New
M1226 Iop measurement not documented, reason not otherwise specified   New
M1227 Evidence-based therapy was prescribed   New
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 3 months of the reactive hcv antibody test   New
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 reactive hcv antibody test to a clinician who treats hcv infection   New
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 follow up hcv viral test that detects hcv viremia and is not referred to a clinician who treats hcv infection within 1 month and does not have hcv treatment initiated within 3 months of the reactive hcv antibody test, reason not given   New
M1231 Patient receives hcv antibody test with nonreactive result   New
M1232 Patient receives hcv antibody test with reactive result   New
M1233 Patient does not receive hcv antibody test or patient does receive hcv antibody test but results not documented, reason not given   New
M1234 Patient has a reactive hcv antibody test, and has a follow up hcv viral test that does not detect hcv viremia   New
M1235 Documentation or patient report of hcv antibody test or hcv rna test which occurred prior to the performance period   New
M1236 Baseline mrs > 2   New
M1237 Patient reason for not screening for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety (e.g., patient declined or other patient reasons)   New
M1238 Documentation that administration of second recombinant zoster vaccine could not occur during the performance period due to the recommended 2-6 month interval between doses (i.e, first dose received after october 31)   New
M1239 Patient did not respond to the question of patient felt heard and understood by this provider and team   New
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 care   New
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   New
M1242 Patient did not respond to the question of patient felt this provider and team understood what is important to me in my life   New
M1243 Patient provided a response other than “completely true” for the question of patient felt heard and understood by this provider and team   New
M1244 Patient provided a response other than “completely true” for the question of patient felt this provider and team put my best interests first when making recommendations about my care   New
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 someone with a medical problem   New
M1246 Patient provided a response other than “completely true” for the question of patient felt this provider and team understood what is important to me in my life   New
M1247 Patient responded “completely true” for the question of patient felt this provider and team put my best interests first when making recommendations about my care   New
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 problem   New
M1249 Patient responded “completely true” for the question of patient felt this provider and team understood what is important to me in my life   New
M1250 Patient responded as “completely true” for the question of patient felt heard and understood by this provider and team   New
M1251 Patients for whom a proxy completed the entire hu survey on their behalf for any reason (no patient involvement)   New
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 ambulatory palliative care visit   New
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 last 60 days (disavowal)   New
M1254 Patients who were deceased when the hu survey reached them   New
M1255 Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere)   New
M1256 Prior history of known cvd   New
M1257 Cvd risk assessment not performed or incomplete (e.g., cvd risk assessment was not documented), reason not otherwise specified   New
M1258 Cvd risk assessment performed, have a documented calculated risk score   New
M1259 Patients listed on the kidney-pancreas transplant waitlist or who received a living donor transplant within the first year following initiation of dialysis   New
M1260 Patients who were not listed on the kidney-pancreas transplant waitlist or patients who did not receive a living donor transplant within the first year following initiation of dialysis   New
M1261 Patients that were on the kidney or kidney-pancreas waitlist prior to initiation of dialysis   New
M1262 Patients who had a transplant prior to initiation of dialysis   New
M1263 Patients in hospice on their initiation of dialysis date or during the month of evaluation   New
M1264 Patients age 75 or older on their initiation of dialysis date   New
M1265 Cms medical evidence form 2728 for dialysis patients: initial form completed   New
M1266 Patients admitted to a skilled nursing facility (snf)   New
M1267 Patients not on any kidney or kidney-pancreas transplant waitlist or is not in active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period   New
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   New
M1269 Receiving esrd mcp dialysis services by the provider on the last day of the reporting month   New
M1270 Patients not on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period   New
M1271 Patients with dementia at any time prior to or during the month   New
M1272 Patients on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period   New
M1273 Patients who were admitted to a skilled nursing facility (snf) within one year of dialysis initiation according to the cms-2728 form   New
M1274 Patients who were admitted to a skilled nursing facility (snf) during the month of evaluation were excluded from that month   New
M1275 Patients determined to be in hospice were excluded from month of evaluation and the remainder of reporting period   New
M1276 Bmi documented outside normal parameters, no follow-up plan documented, no reason given   New
M1277 Colorectal cancer screening results documented and reviewed   New
M1278 Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented   New
M1279 Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given   New
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 unilateral mastectomy   New
M1281 Blood pressure reading not documented, reason not given   New
M1282 Patient screened for tobacco use and identified as a tobacco non-user   New
M1283 Patient screened for tobacco use and identified as a tobacco user   New
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 than 90 consecutive days during the measurement period   New
M1285 Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified   New
M1286 Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason   New
M1287 Bmi is documented below normal parameters and a follow-up plan is documented   New
M1288 Documented reason for not screening or recommending a follow-up for high blood pressure   New
M1289 Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)   New
M1290 Patient not eligible due to active diagnosis of hypertension   New
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 dementia during the measurement period or the year prior to the measurement period   New
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 encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period   New
M1293 Bmi is documented above normal parameters and a follow-up plan is documented   New
M1294 Normal blood pressure reading documented, follow-up not required   New
M1295 Patients with a diagnosis or past history of total colectomy or colorectal cancer   New
M1296 Bmi is documented within normal parameters and no follow-up plan is required   New
M1297 Bmi not documented due to medical reason or patient refusal of height or weight measurement   New
M1298 Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter   New
M1299 Influenza immunization administered or previously received   New
M1300 Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)   New
M1301 Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)   New
M1302 Screening, diagnostic, film digital or digital breast tomosynthesis (3d) mammography results documented and reviewed   New
M1303 Hospice services provided to patient any time during the measurement period   New
M1304 Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period   New
M1305 Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period   New
M1306 Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period   New
M1307 Documentation stating the patient has received or is currently receiving palliative or hospice care   New
M1308 Influenza immunization was not administered, reason not given   New
M1309 Palliative care services provided to patient any time during the measurement period   New
M1310 Patient screened for tobacco use and received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling, pharmacotherapy, or both), if identified as a tobacco user   New
M1311 Anaphylaxis due to the vaccine on or before the date of the encounter   New
M1312 Patient not screened for tobacco use   New
M1313 Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period   New
M1314 Bmi not documented and no reason is given   New
M1315 Colorectal cancer screening results were not documented and reviewed; reason not otherwise specified   New
M1316 Current tobacco non-user   New
M1317 Patients who are counseled on connection with a csp and explicitly opt out   New
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 documentation that there was no contact with a csp   New
M1319 Patients who had documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening   New
M1320 Patients who screened positive for at least 1 of the 5 hrsns   New
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 documented if the iop was >25 mm hg   New
M1322 Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with documented iop =<25 mm hg for injected eye   New
M1323 Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with documented iop >25 mm hg and a plan of care was documented   New
M1324 Patients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, dexamethasone intravitreal implant, or fluocinolone intravitreal implant)   New
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 received a prior intravitreal or periocular steroid injection within the last six (6) months and had a subsequent iop evaluation with iop <25mm hg within seven (7) weeks of treatment)   New
M1326 Patients with a diagnosis of hypotony   New
M1327 Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 8 weeks   New
M1328 Patients with a diagnosis of acute vitreous hemorrhage   New
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 acute pvd encounter   New
M1330 Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up)   New
M1331 Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 8 weeks from initial exam   New
M1332 Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 2 weeks   New
M1333 Acute vitreous hemorrhage   New
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 acute pvd encounter   New
M1335 Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up)   New
M1336 Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 2 weeks   New
M1337 Acute pvd   New
M1338 Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores during the performance period   New
M1339 Patients who had follow-up assessment 30 to 180 days after the index assessment who demonstrated positive improvement or maintenance of functioning scores during the performance period   New
M1340 Index assessment completed using the 12-item whodas 2.0 or sds during the denominator identification period   New
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 performance period   New
M1342 Patients who died during the performance period   New
M1343 Patients who are at pam level 4 at baseline or patients who are flagged with extreme straight line response sets on the pam   New
M1344 Patients who did not have a baseline pam score and/or a second score within 6 to 12 month of baseline pam score   New
M1345 Patients who had a baseline pam score and a second score within 6 to 12 month of baseline pam score   New
M1346 Patients who did not have a net increase in pam score of at least 6 points within a 6 to 12 month period   New
M1347 Patients who achieved a net increase in pam score of at least 3 points in a 6 to 12 month period (passing)   New
M1348 Patients who achieved a net increase in pam score of at least 6-points in a 6 to 12 month period (excellent)   New
M1349 Patients who did not have a net increase in pam score of at least 3 points within 6 to 12 month period   New
M1350 Patients who had a completed suicide safety plan initiated, reviewed or updated in collaboration with their clinician (concurrent or within 24 hours) of the index clinical encounter   New
M1351 Patients who had a suicide safety plan initiated, reviewed, or updated and reviewed and updated in collaboration with the patient and their clinician concurrent or within 24 hours of clinical encounter and within 120 days after initiation   New
M1352 Suicidal ideation and/or behavior symptoms based on the c-ssrs or equivalent assessment   New
M1353 Patients who did not have a completed suicide safety plan initiated, reviewed or updated in collaboration with their clinician (concurrent or within 24 hours) of the index clinical encounter   New
M1354 Patients who did not have a suicide safety plan initiated, reviewed, or updated or reviewed and updated in collaboration with the patient and their clinician concurrent or within 24 hours of clinical encounter and within 120 days after initiation   New
M1355 Suicide risk based on their clinician’s evaluation or a clinician-rated tool   New
  
M1356 Patients who died during the measurement period   New
M1357 Patients who had a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment   New
M1358 Patients who did not have a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment   New
M1359 Index assessment during the denominator period when the suicidal ideation and/or behavior symptoms or increased suicide risk by clinician determination occurs and a non-zero c-ssrs score is obtained   New
M1360 Suicidal ideation and/or behavior symptoms based on the c-ssrs   New
M1361 Suicide risk based on their clinician’s evaluation or a clinician-rated tool   New
M1362 Patients who died during the measurement period   New
M1363 Patients who did not have a follow-up assessment within 120 days of the index assessment   New
M1364 Calculated 10-year ascvd risk score of >= 20 percent during the performance period   New
M1365 Patient encounter during the performance period with hospice and palliative care specialty code 17   New
M1366 Focusing on women’s health mips value pathway   New
M1367 Quality care for the treatment of ear, nose, and throat disorders mips value pathway   New
M1368 Prevention and treatment of infectious disorders including hepatitis c and hiv mips value pathway   New
M1369 Quality care in mental health and substance use disorders mips value pathway   New
M1370 Rehabilitative support for musculoskeletal care mips value pathway

What are M Codes?

HCPCS M-Codes, part of (HCPCS) Level-II code set, are alphanumeric codes used to identify and report specific medical services/procedures. The HCPCS M-Codes play a crucial role in the healthcare industry by providing a standardized way to communicate and document medical services. Their accurate use ensures fair reimbursement, regulatory compliance, and contributes to the overall efficiency of the healthcare system.

The purpose of these HCPCS codes is to facilitate uniform reporting for Medicare and other healthcare programs. Ensure that providers, payers, and insurances have a common language to accurately describe medical services using M-Codes. Moreover, the specificity of M Codes allows for detailed billing. It helps in the identification of specific medical procedures, making it easier to determine the appropriate reimbursement.

Importance of HCPCS M Codes

M-Codes are of paramount importance in medical billing for several reasons:

  • Accurate Reimbursement:

By using HCPCS M codes, healthcare providers can precisely describe the services or items provided, leading to accurate reimbursement. Payers rely on these M-Codes to determine the appropriate payment for each service or item. M-Codes ensure accurate and standardized billing for medical services.

  • Regulatory Compliance:

Compliance with Medicare and other federally-funded healthcare programs is critical for healthcare providers. Proper use of M-codes ensures adherence to coding guidelines and regulations, reducing the risk of audits and penalties.

  • Claims Processing:

Payers use M-Codes to process claims efficiently, reducing errors and streamlining the reimbursement process for healthcare providers.

  • Data Analysis:

These M codes play a crucial role in healthcare analytics, enabling researchers and policymakers to analyze trends, outcomes, and utilization patterns in medical services.

  • Uniform Reporting:

M-codes provide a standardized system for reporting medical services, fostering consistency across the healthcare industry. This consistency is essential for data analysis, research, and overall improvement in the quality of healthcare services.

Conclusion

In conclusion, mastering HCPCS M-Codes is paramount for healthcare professionals seeking to navigate the intricate landscape of medical billing and coding. This comprehensive guide, therefore, serves as a valuable resource for healthcare professionals seeking a deep understanding of M-codes. Navigate our guide with confidence; furthermore, Check our complete HCPCS Codes Lookup to enhance your coding proficiency. Moreover, Empower yourself and your healthcare organization with the knowledge for efficient billing, compliance, and optimal patient care.

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