2025 HCPCS code M1028
(Active) Effective Date: N/A Quality Measures - Screening Procedures Head Imaging M1003-M1070 Feed
Documentation of patients with a primary headache diagnosis and imaging other than CT or MRI obtained.
No modifiers are applicable to this code.
Medical necessity is determined by the individual patient's circumstances and clinical presentation. It’s crucial to remember that M1028 is not intended for billing or reimbursement; it serves as a quality measure for tracking potential overutilization of imaging studies for primary headaches. Although it doesn't impact reimbursement directly, appropriate use of imaging affects overall healthcare costs and patient outcomes.
This code is reported by healthcare providers participating in Medicare quality payment programs. It's used to track and measure the appropriate use of imaging for primary headaches. The clinician's responsibility is to accurately document when this code applies and include it for quality reporting purposes.
In simple words: This code is used by healthcare professionals to track if a patient with a headache that isn't caused by another health problem, like a migraine or tension headache, has had a head scan other than a CT or MRI scan. This helps doctors understand if too many head scans are being done when they might not be needed.
This code is used for quality measure reporting for patients with a primary headache diagnosis who undergo head imaging other than computed tomography (CT) or magnetic resonance imaging (MRI). Primary headaches are those not caused by other medical conditions, such as migraines, tension headaches, and cluster headaches.This code is intended to track and assess potential overuse of imaging in these cases.
Example 1: A patient presents with a migraine. The physician orders a head X-ray to rule out other causes. The physician can report M1028 since a head X-ray, and not a CT or MRI, was performed for a patient diagnosed with a primary headache disorder., A patient with a history of tension headaches reports increased frequency and intensity. The physician orders a head ultrasound. The physician can report M1028 as an ultrasound was used, not a CT or MRI., A patient experiences cluster headaches.The physician conducts a physical examination and decides against imaging. M1028 would not be reported because no head imaging other than CT or MRI was performed.
Documentation must support the diagnosis of a primary headache disorder and the medical reason for the imaging performed. The type of imaging performed must also be clearly documented.
** This code is a quality measure and does not affect reimbursement. It is important to use this code accurately to reflect the appropriate utilization of imaging for primary headache disorders. Always refer to the latest CMS guidelines for accurate reporting.
- Payment Status: Not Paid
- Modifier TC rule: Not applicable.
- Specialties:Neurology, Primary Care, Pain Management
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital, Independent Clinic, Federally Qualified Health Center, Other Place of Service