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2025 HCPCS code M1029

Performance measure exclusion modifier - primary headache; imaging of the head (CT or MRI) obtained.

This code is used solely for quality reporting under specific programs like MIPS and is not tied to direct reimbursement. It's essential to ensure proper documentation supports the medical decision-making process leading to the imaging procedure itself, and that any other billable services are accurately coded alongside M1029.

While the code itself signifies a potential overuse of imaging, medical necessity for *performing* the imaging procedure (CT or MRI) hinges on individual patient presentation and professional judgment. Clear documentation justifying the decision to image despite guideline recommendations is crucial. Generally, primary headache diagnoses without accompanying red flags or abnormal neurological findings do not meet typical medical necessity criteria for advanced head imaging.

Clinicians participating in quality reporting programs use this code to document cases where a head CT or MRI was performed for a patient diagnosed with a primary headache, without clear clinical justification according to established guidelines. This aids in performance tracking and potential improvements in diagnostic practices.

IMPORTANT:Related codes for different scenarios with primary headache patients concerning head imaging are: M1027 (Performance Met - CT or MRI obtained), M1028 (Denominator Exception - other imaging obtained), and M1030 (Performance Not Met - CT or MRI not obtained and Reason given).

In simple words: This code is used when a patient with a headache without other symptoms undergoes a head CT or MRI scan.

This code is used for quality measure reporting for patients with a primary headache diagnosis when imaging of the head (Computed Tomography (CT) or Magnetic Resonance Imaging (MRI)) is performed. This HCPCS code is specifically for tracking instances where imaging IS performed, even when potentially not clinically indicated based on established guidelines.

Example 1: A 40-year-old patient presents with a new episodic headache diagnosed as a migraine. A CT scan is performed despite the absence of red flags. This scenario triggers the reporting of M1029., A 25-year-old patient has a recurrent tension headache. An MRI is ordered even though symptoms are well managed and there are no alarming clinical signs. This instance is reported using M1029., A 55-year-old patient with chronic, stable migraines and no new neurological symptoms undergoes a CT scan of the head during a routine visit. The use of M1029 is necessary for quality reporting in this case.

Complete documentation should include the diagnosis of primary headache, the type of imaging study (CT or MRI) performed, the date of the study, the reason for ordering the imaging, and any related clinical findings like neurological exam results or other symptoms.

** M1029 is a quality measure code used in reporting potential overuse of head imaging for primary headaches. It's not intended for reimbursement. Always ensure compliance with latest coding guidelines and clinical justifications are documented for imaging ordered.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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