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.
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.
- Payment Status: Not Applicable