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ALL MEDICAL CODES IN CATEGORY Other Services

2025 HCPCS code M1264

Patient was 75 or older at the start of dialysis.

2025 HCPCS code M1205

Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score.

2025 HCPCS code T1H

Lab tests - other (non-medicare fee schedule).

2025 HCPCS code G0496

Skilled services of a licensed practical nurse (LPN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.

2025 HCPCS code M1365

Records a patient encounter with a hospice and palliative care provider (specialty code 17) during a performance period.

2025 HCPCS code T1014

Telehealth transmission, per minute. Professional services billed separately.

2025 HCPCS code M1269

Receiving end-stage renal disease (ESRD) monthly capitated payment (MCP) dialysis services by the provider on the last day of the reporting month.

2025 HCPCS code M1355

Assessment of suicide risk based on clinician evaluation or a clinician-rated tool.

2025 HCPCS code M1354

This code tracks the absence of a suicide safety plan initiation, review, or update within specific timeframes of a clinical encounter.

2025 HCPCS code M1347

Patient achieved a net increase of at least 3 points in their Patient Activation Measure (PAM) score within 6-12 months.

2025 HCPCS code M1335

Documentation of patient reason(s) for not having a follow-up exam (e.g., inadequate time for follow up).

2025 HCPCS code M1246

Patient did not report "completely true" to the question, "Patient felt this provider and team understood what is important to me in my life."

2025 HCPCS code M1211

Most recent hemoglobin A1c level > 9.0%

2025 HCPCS code M1240

Patient did not respond to the question of whether they felt the provider and team put their best interests first when making recommendations about their care.

2025 HCPCS code M1150

Left ventricular ejection fraction (LVEF) less than or equal to 40% or moderately/severely depressed left ventricular systolic function.

2025 HCPCS code M1208

This code represents a patient not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety.

2025 HCPCS code M1151

This code identifies patients with a history of heart transplant or with a left ventricular assist device (LVAD).

2025 HCPCS code M1260

Patient not listed on kidney-pancreas transplant waitlist and did not receive a living donor transplant within one year of starting dialysis.

2025 HCPCS code M1163

Patient had anaphylaxis due to the HPV vaccine on or before the patient's 13th birthday. This is a tracking code for performance measurement.

2025 HCPCS code M1203

This code is used for patients with chronic kidney disease and proteinuriawho were not prescribed ACE inhibitor or ARB therapy during the measurement period, and no reason was given for not prescribing.

2025 HCPCS code M1204

Initial itch severity assessment score of 4 or greater using NRS, VRS, or ItchyQuant.

2025 HCPCS code M1147

Ongoing care not medically possible due to early discharge for medical reasons.

2025 HCPCS code M1165

Patient received hospice care during the measurement period.

2025 HCPCS code M1243

Patient provided a response other than "completely true" for the question of patient felt heard and understood by this provider and team.

2025 HCPCS code M1167

Indicates the patient received hospice services during the measurement period for performance tracking.

2025 HCPCS code M1171

Patient received at least one Td or Tdap vaccine between 9 years prior to the encounter and the end of the measurement period.

2025 HCPCS code M1168

Patient received an influenza vaccine between July 1 of the prior year and June 30 of the measurement period.

2025 HCPCS code M1178

Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., prior anaphylaxis due to the pneumococcal vaccine). This is a tracking code for performance measurement.

2025 HCPCS code M1146

Ongoing care not clinically indicated due to patient needing home program, referral, or consultation only.

2025 HCPCS code M1149

This code reports a patient's inability to complete a neck functional status assessment due to specific limitations, and no adequate proxy is available.

2025 HCPCS code M1166

Pathology report for tissue specimens from wide local excisions or re-excisions.

2025 HCPCS code M1155

Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period.

2025 HCPCS code M1177

This code tracks whether patients aged 60 or older received a pneumococcal vaccine (conjugate or polysaccharide).

2025 HCPCS code M1195

Surgical pathology reports lacking impression/conclusion or recommendation for MMR by immunohistochemistry, MSI by DNA testing, or both, reason not given.

2025 HCPCS code M1201

Documentation of medical reason(s) for not prescribing ACE inhibitor (ACE-I) or ARB therapy during the measurement period.

2025 HCPCS code M1182

Patient is not eligible due to pre-existing inflammatory bowel disease (IBD).

2025 HCPCS code M1193

Surgical pathology reports containing impression/conclusion/recommendation for MMR by immunohistochemistry, MSI by DNA testing, or both.

2025 HCPCS code M1256

Prior history of known CVD.

2025 HCPCS code 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.

2025 HCPCS code M1231

Patient receives HCV antibody test with nonreactive result.

2025 HCPCS code M1232

Patient receives HCV antibody test with a reactive result.

2025 HCPCS code M1230

Patient with reactive HCV antibody test without follow-up viral test, or with follow-up test detecting viremia but no referral or treatment initiated within specified timeframes, reason not given.

2025 HCPCS code M1261

Documents that the patient was on the kidney or kidney-pancreas transplant waitlist before starting dialysis.

2025 HCPCS code M1273

Patient admitted to a skilled nursing facility (SNF) within one year of dialysis initiation, documented on CMS-2728.

2025 HCPCS code M1257

CVD risk assessment not performed or incomplete, reason not otherwise specified.

2025 HCPCS code M1238

Documentation that administration of the second recombinant zoster vaccine could not occur during the performance period due to the recommended 2-6 month interval between doses (i.e., the first dose was received after October 31st).

2025 HCPCS code M1255

This code is used for patients who have a positive pregnancy test but visited the clinic for reasons other than prenatal or postpartum care and have not established the clinic as their obstetric provider.

2025 HCPCS code M1319

Patients who had documented contact with a community service provider (CSP) for at least one of their screened positive health-related social needs (HRSNs) within 60 days after screening.

2025 HCPCS code M1318

No documented contact with a community service provider (CSP) for a screened positive health-related social need (HRSN) within 60 days of screening, or documentation of no contact.

2025 HCPCS code M1281

Blood pressure reading not documented, reason not given.

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