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2025 HCPCS code M1327

This code is used for patients who did not receive an appropriate initial evaluation or a re-evaluation within 8 weeks, as required.

This code is a supplemental tracking code used for data collection and performance measurement and should not be used in place of a code describing the procedure or service rendered. It is typically used by providers participating in quality improvement programs and should be reported according to the specific guidelines of those programs.

The medical record must indicate that the patient did not receive an appropriate evaluation during the initial exam or was not given a subsequent re-evaluation within the eight-week period, as specified by the relevant program measure.

In simple words: This code tracks if a patient didn't have the right check-up at first or within 8 weeks of the first check-up.

Documents that the patient was not appropriately evaluated during the initial exam and/or was not re-evaluated within the specified timeframe of 8 weeks. This is a supplemental tracking code that may be appropriate for data collection and performance measurement. It is not a substitute for a code describing the actual procedure or service rendered.

Example 1: A patient with diabetes is enrolled in a care management program that requires an initial assessment and a follow-up evaluation within 8 weeks. The initial assessment is performed, but the patient does not return for the follow-up within the required timeframe. Code M1327 is reported to track this missed evaluation., A patient with hypertension is seen by their physician, but no formal evaluation or plan of care is documented. The patient is scheduled for a follow-up visit, but this does not occur within 8 weeks. Code M1327 is reported because both the appropriate initial evaluation and the timely re-evaluation are missing., A patient presents for an initial evaluation for low back pain. A thorough assessment is performed, and a treatment plan is initiated. However, despite scheduling a follow-up, the patient does not return for any further evaluation within 8 weeks. Code M1327 is reported to indicate the missed re-evaluation.

Documentation should clearly demonstrate that the required initial evaluation or the re-evaluation within the 8-week timeframe was not performed, along with the reasons for the missed evaluation(s). The specific requirements of the relevant program measure should be adhered to.

** HCPCS Level II M codes are often used by providers participating in programs designed to improve the quality of patient care through incentives. Refer to program guidelines for complete submission requirements and procedures.

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

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