2025 HCPCS code M1027
(Active) Effective Date: N/A Revision Date: N/A Head Imaging - Screening Procedures Feed
Performance Measure Reporting Modifier for Head CT/MRI for Primary Headache Evaluation.
Medical necessity is determined by the clinical need for the head CT/MRI based on the patient's symptoms and medical history.However, the M1027 code is specifically for quality reporting related to imaging for primary headaches without other clinical indications and does not itself determine medical necessity for the imaging procedure.
Reported by providers for each denominator-eligible visit during the performance period when a patient undergoes head CT or MRI for primary headache evaluation without clinical indications.
In simple words: This code is used by healthcare providers to track whether a patient received a head CT or MRI scan for a primary headache when there were no other medical reasons for the scan. This helps improve the quality of care.It does not affect billing or payment.
Performance measure code reported when a patient undergoes head CT or MRI for evaluation of primary headache (e.g., migraine, tension, cluster headaches) without clinical indications, for quality measurement reporting in Medicare quality payment programs (QPP). Not used for reimbursement purposes.
Example 1: A patient presents with a migraine headache. A head CT is performed to rule out other causes, although clinical findings suggest a primary headache. M1027 is reported., A patient with a history of tension headaches experiences a severe headache. An MRI is performed to assess for underlying conditions despite a likely primary headache diagnosis. M1027 is reported., A patient experiences a cluster headache. A head CT is performed as part of the initial evaluation, even though the symptoms point towards a primary headache disorder. M1027 is reported.
Documentation supporting the diagnosis of primary headache, the reason for the head CT/MRI, and the absence of other clinical indications.
** This code is for quality measure reporting only and is not billable. It is important to differentiate the use of this code from the actual codes used for billing the imaging procedures themselves.
- Payment Status: Not applicable for reimbursement
- Specialties:Neurology, Radiology, Primary Care
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital, Independent Clinic, Federally Qualified Health Center, Rural Health Clinic