HCPCS M codes: Medical services
451 active HCPCS Level II codes beginning with M, from the CMS October 2026 quarterly file. "Added" is the year the code first appeared in the HCPCS file.
| Code | Long description | Short description | Added |
|---|---|---|---|
M0001 | Advancing cancer care mips value pathways | Advancing cancer care mvp | 2023 |
M0002 | Optimal care for kidney health mips value pathways | Opt care kidney hlth mvp | 2023 |
M0004 | Quality care for patients with neurological conditions mips value pathway | Qual care neurologic cnd mvp | 2023 |
M0005 | Value in primary care mips value pathway | Value in primary care mvp | 2023 |
M0010 | Enhancing oncology model (eom) monthly enhanced oncology services (meos) payment for eom enhanced services | Eom meos payment | 2023 |
M0075 | Cellular therapy | Cellular therapy | 1986 |
M0076 | Prolotherapy | Prolotherapy | 1986 |
M0100 | Intragastric hypothermia using gastric freezing | Intragastric hypothermia | 1986 |
M0201 | Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient's home | Pne flu hepb cov home admin | 2021 |
M0224 | Intravenous infusion, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known sars-cov-2 exposure, who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, includes infusion and post administration monitoring | Pemivibart infusion | 2024 |
M0231 | Intravenous infusion, tocilizumabbavi, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation only, includes infusion and post administration monitoring, first dose | Inf tocilizumab-bavi 1st dos | 2026 |
M0232 | Intravenous infusion, tocilizumabbavi, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation only, includes infusion and post administration monitoring, second dose | Inf tocilizumab-bavi 2nd dos | 2026 |
M0233 | Intravenous infusion, tocilizumab-aazg, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, first dose | Intra inf, toci, first dose | 2026 |
M0234 | Intravenous infusion, tocilizumab-aazg, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, second dose | Intra inf, toci, second dos | 2026 |
M0235 | Intravenous infusion, monoclonal antibody products with an indication for post-exposure prophylaxis or treatment of covid-19, for hospitalized adults and/or pediatric patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, not otherwise classified, first dose | Intrav inf, mon anti, fir do | 2025 |
M0236 | Intravenous infusion, monoclonal antibody products with an indication for post-exposure prophylaxis or treatment of covid-19, for hospitalized adults and/or pediatric patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, not otherwise classified, second dose | Intrav inf, mon anti, sec do | 2025 |
M0237 | Intravenous infusion, tocilizumab-anoh, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, first dose | Intrav inf, toci, first dose | 2025 |
M0238 | Intravenous infusion, tocilizumab-anoh, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, second dose | Intrav inf, toci, second dos | 2025 |
M0249 | Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, first dose | Adm tocilizu covid-19 1st | 2021 |
M0250 | Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, second dose | Adm tocilizu covid-19 2nd | 2021 |
M0300 | Iv chelation therapy (chemical endarterectomy) | Iv chelationtherapy | 1986 |
M0301 | Fabric wrapping of abdominal aneurysm | Fabric wrapping of aneurysm | 1986 |
M1003 | Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic and/or immune response modifier therapy | Tb scr 12 mo pri fst bio dz | 2019 |
M1004 | Documentation of medical reason for not screening for tb or interpreting results (i.e., patient positive for tb and documentation of past treatment; patient who has recently completed a course of anti-tb therapy) | Doc med rsn no srn tb | 2019 |
M1005 | Tb screening not performed or results not interpreted, reason not given | Tb scr no perf | 2019 |
M1006 | Disease activity not assessed, reason not given | Dz not ases, no rsn | 2019 |
M1007 | >=50% of total number of a patient's outpatient ra encounters assessed | >=50% total pt outpt ra enct | 2019 |
M1008 | <50% of total number of a patient's outpatient ra encounters assessed | <50% total pt outpt ra encts | 2019 |
M1009 | Discharge/discontinuation of the episode of care documented in the medical record | Dc eoc doc med rec | 2019 |
M1010 | Discharge/discontinuation of the episode of care documented in the medical record | Dc eoc doc med rec | 2019 |
M1011 | Discharge/discontinuation of the episode of care documented in the medical record | Dc eoc doc med rec | 2019 |
M1012 | Discharge/discontinuation of the episode of care documented in the medical record | Dc eoc doc med rec | 2019 |
M1013 | Discharge/discontinuation of the episode of care documented in the medical record | Dc eoc doc med rec | 2019 |
M1014 | Discharge/discontinuation of the episode of care documented in the medical record | Dc epi care doc medrec | 2019 |
M1016 | Female patients unable to bear children | Pt dx meop or sur steri | 2019 |
M1018 | Patients with an active diagnosis or history of cancer (except basal cell and squamous cell skin carcinoma), patients who are heavy tobacco smokers, lung cancer screening patients | Pt dx hst cr pt sk lg cr scr | 2019 |
M1019 | Adolescent patients 12 to 17 years of age with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5 | Adl pt mj dep ds rs 12 phq<5 | 2019 |
M1020 | Adolescent patients 12 to 17 years of age with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq-9 or phq-9m score was not assessed or is greater than or equal to 5 | Adl pt mj dep ds no rs 12 mo | 2019 |
M1021 | Patient had only urgent care visits during the performance period | Pt uc in pp | 2019 |
M1027 | Imaging of the head (ct or mri) was obtained | Img head (ct or mri) obtnd | 2019 |
M1028 | Documentation of patients with primary headache diagnosis and imaging other than ct or mri obtained | Doc of pt prm hda dx and otr | 2019 |
M1029 | Imaging of the head (ct or mri) was not obtained, reason not given | Doc sysm rsn img hd | 2019 |
M1032 | Adults currently taking pharmacotherapy for oud | Adt tkng pharmthry for oud | 2019 |
M1034 | Adults who have at least 180 days of continuous pharmacotherapy with a medication prescribed for oud without a gap of more than seven days | Adt 180 dys pharmthry oud | 2019 |
M1035 | Adults who are deliberately phased out of medication assisted treatment (mat) prior to 180 days of continuous treatment | Adt pd out mat pr 180 dys tx | 2019 |
M1036 | Adults who have not had at least 180 days of continuous pharmacotherapy with a medication prescribed for oud without a gap of more than seven days | Adt no 180 dys pharmthry oud | 2019 |
M1037 | Patients with a diagnosis of lumbar spine region cancer at the time of the procedure | Pt dx lum sp reg cacr | 2019 |
M1038 | Patients with a diagnosis of lumbar spine region fracture at the time of the procedure | Pt dx lum sp reg fract | 2019 |
M1039 | Patients with a diagnosis of lumbar spine region infection at the time of the procedure | Pt dx lum sp reg inf | 2019 |
M1040 | Patients with a diagnosis of lumbar idiopathic or congenital scoliosis | Pt dx lum idi or cong scol | 2019 |
M1041 | Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis | Pt cr ft inf lm or pt id sl | 2019 |
M1043 | Functional status was not measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively | Fs no odi 9-15mo | 2019 |
M1045 | Functional status measured by the oxford knee score (oks) at one year (9 to 15 months) postoperatively was greater than or equal to 37 or knee injury and osteoarthritis outcome score joint replacement (koos, jr.) was greater than or equal to 71 | Fs oks 9-15mo >= 37 >= 71 | 2019 |
M1046 | Functional status measured by the oxford knee score (oks) at one year (9 to 15 months) postoperatively was less than 37 or the knee injury and osteoarthritis outcome score joint replacement (koos, jr.) was less than 71 postoperatively | Fs oks 9-15mo < 37 < 71 | 2019 |
M1049 | Functional status was not measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively | Fs wth scr no odi pre and p | 2019 |
M1051 | Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis | Pt w/cancer scoliosis | 2019 |
M1052 | Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively | Lg pn not meas w/ vas 1yr po | 2019 |
M1054 | Patient had only urgent care visits during the performance period | Pt uc in pp | 2019 |
M1055 | Aspirin or another antiplatelet therapy used | Aspirin used | 2019 |
M1056 | Prescribed anticoagulant medication during the performance period, history of gi bleeding, history of intracranial bleeding, bleeding disorder and specific provider documented reasons: allergy to aspirin or anti-platelets, use of non-steroidal anti-inflammatory agents, drug-drug interaction, uncontrolled hypertension > 180/110 mmhg or gastroesophageal reflux disease | Presc antico med in pp | 2019 |
M1057 | Aspirin or another antiplatelet therapy not used, reason not given | Aspirin not used, no rsn | 2019 |
M1058 | Patient was a permanent nursing home resident at any time during the performance period | Pt prm nurs hm res in pp | 2019 |
M1059 | Patient was in hospice or receiving palliative care at any time during the performance period | Pt no prm nurs hm res in pp | 2019 |
M1060 | Patient died prior to the end of the performance period | Pt died in pp | 2019 |
M1067 | Hospice services for patient provided any time during the measurement period | Hspc pt prv time meam per | 2019 |
M1068 | Adults who are not ambulatory | Pt not ambulatory | 2019 |
M1069 | Patient screened for future fall risk | Pt scr ft fall rsk | 2019 |
M1070 | Patient not screened for future fall risk, reason not given | Pt not scrn fut fall no rsn | 2019 |
M1106 | The start of an episode of care documented in the medical record | Start eoc doc med rec | 2020 |
M1107 | Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care | Docu dx degen neuro | 2020 |
M1108 | Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record | Oc ni pt home prog | 2020 |
M1109 | Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery | Oc ni pt dc | 2020 |
M1110 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) | Oc not p pt selfdc | 2020 |
M1111 | The start of an episode of care documented in the medical record | Start eoc doc med rec | 2020 |
M1112 | Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care | Docu dx degen neuro | 2020 |
M1113 | Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record | Oc ni pt home prog | 2020 |
M1114 | Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery | Oc ni pt dc | 2020 |
M1115 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) | Oc ni pt selfdc | 2020 |
M1116 | The start of an episode of care documented in the medical record | Start eoc doc med rec | 2020 |
M1117 | Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care | Docu dx degen neuro | 2020 |
M1118 | Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record | Oc ni pt home prog | 2020 |
M1119 | Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery | Oc ni pt dc | 2020 |
M1120 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) | Oc ni pt selfdc | 2020 |
M1121 | The start of an episode of care documented in the medical record | Start eoc doc med rec | 2020 |
M1122 | Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care | Docu dx degen neuro | 2020 |
M1123 | Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record | Oc ni pt home prog | 2020 |
M1124 | Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery | Oc ni pt dc 1-2 vis | 2020 |
M1125 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) | Oc ni pt selfdc 1-2 vis | 2020 |
M1126 | The start of an episode of care documented in the medical record | Start eoc doc med rec | 2020 |
M1127 | Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care | Docu dx degen neuro | 2020 |
M1128 | Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record | Oc ni pt home prog | 2020 |
M1129 | Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery | Oc ni pt dc | 2020 |
M1130 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) | Oc ni pt selfdc | 2020 |
M1131 | Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of care | Docu dx degen neuro | 2020 |
M1132 | Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record | Oc ni pt home prog | 2020 |
M1133 | Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery | Oc ni pt dc | 2020 |
M1134 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) | Oc ni pt selfdc | 2020 |
M1135 | The start of an episode of care documented in the medical record | Start eoc doc med rec | 2020 |
M1141 | Functional status was not measured by the oxford knee score (oks) or the knee injury and osteoarthritis outcome score joint replacement (koos, jr.) at one year (9 to 15 months) postoperatively | Fs no oks | 2020 |
M1142 | Emergent cases | Emerge cases | 2020 |
M1143 | Initiated episode of rehabilitation therapy, medical, or chiropractic care for neck impairment | Ni rehab med chiro | 2020 |
M1146 | Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record | Ongoing care not ind | 2021 |
M1147 | Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery | Care not poss med rsn | 2021 |
M1148 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) | Pt self dschg | 2021 |
M1149 | Patient unable to complete the neck fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility, and an adequate proxy is not available | No neck fs prom incap | 2021 |
M1150 | Current or prior left ventricular ejection fraction (lvef) less than or equal to 40% or documentation of moderately or severely depressed left ventricular systolic function | Lvef <=40% or mod/sev l vsf | 2023 |
M1151 | Patients with a history of heart transplant or with a left ventricular assist device (lvad) | Pt w/ hx trnsplt or lvad | 2023 |
M1152 | Patients with a history of heart transplant or with a left ventricular assist device (lvad) | Pt w/ hx trnsplt or lvad | 2023 |
M1153 | Patient with diagnosis of osteoporosis on date of encounter | Pt w/ dx osteo doe | 2023 |
M1159 | Hospice services provided to patient any time during the measurement period | Hospc serv dur meas pd | 2023 |
M1160 | Patient had anaphylaxis due to the meningococcal vaccine any time on or before the patient's 13th birthday | Pt anphx due to mengb bef 13 | 2023 |
M1161 | Patient had anaphylaxis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday | Pt anphx due to dtp bef 13 | 2023 |
M1162 | Patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday | Pt enceph due to dtp bef 13 | 2023 |
M1163 | Patient had anaphylaxis due to the hpv vaccine any time on or before the patient's 13th birthday | Pt anphx due to hpv bef 13 | 2023 |
M1164 | Patients with dementia any time during the patient's history through the end of the measurement period | Pt w/ dementia any time | 2023 |
M1165 | Patients who use hospice services any time during the measurement period | Pt use hspc dur meas pd | 2023 |
M1166 | Pathology report for tissue specimens produced from wide local excisions or re-excisions | Path rpt tis spec wle/reexc | 2023 |
M1167 | In hospice or using hospice services during the measurement period | Hspc dur meas pd | 2023 |
M1168 | Patient received an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period | Pt recd flu vax 7/1-6/30 | 2023 |
M1169 | Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine) | Doc med rsn no flu vax | 2023 |
M1170 | Patient did not receive an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period | Pt w/o flu vax 7/1-6/30 | 2023 |
M1171 | Patient received at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period | Pt recd 1 td/tdap 9yrs prior | 2023 |
M1172 | Documentation of medical reason(s) for not administering td or tdap vaccine (e.g., prior anaphylaxis due to the td or tdap vaccine or history of encephalopathy within seven days after a previous dose of a td-containing vaccine) | Doc med rsn no td/tdap | 2023 |
M1173 | Patient did not receive at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period | Pt no rec td/tdap 9yrs prior | 2023 |
M1174 | Patient received at least two doses of the herpes zoster recombinant vaccine (at least 28 days apart) on october 20, 2017, through the end of the measurement period | Pt w/ 2 hzv 10/2017 - mp | 2023 |
M1175 | Documentation of medical reason(s) for not administering zoster vaccine (e.g., prior anaphylaxis due to the zoster vaccine) | Doc med rsn no hzv | 2023 |
M1176 | Patient did not receive two doses of the herpes zoster recombinant vaccine (at least 28 days apart) on october 20, 2017, through the end of the measurement period | No 2 hzv 10/2017-meas pd | 2023 |
M1177 | Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period | Pt recd pcv on/aft 19 | 2023 |
M1178 | Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., prior anaphylaxis due to the pneumococcal vaccine) | Doc med rsn no pcv | 2023 |
M1179 | Patient did not receive any pneumococcal conjugate or polysaccharide vaccine, on or after their 19th birthday and before or during measurement period | No pcv recd | 2023 |
M1180 | Patients on immune checkpoint inhibitor therapy | Pt imm ckpt inhib therapy | 2023 |
M1181 | Grade 2 or above diarrhea and/or grade 2 or above colitis | Gr 2 or> dia or gr2 or> col | 2023 |
M1182 | Patients not eligible due to pre-existing inflammatory bowel disease (ibd) (e.g., ulcerative colitis, crohn's disease) | Not elg pre ex ibd/uc/crohn | 2023 |
M1183 | Documentation of immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered | Doc imm ckpt inhib hld | 2023 |
M1184 | Documentation of medical reason(s) for not prescribing or administering corticosteroid or immunosuppressant treatment (e.g., allergy, intolerance, infectious etiology, pancreatic insufficiency, hyperthyroidism, prior bowel surgical interventions, celiac disease, receiving other medication, awaiting diagnostic workup results for alternative etiologies, other medical reasons/contraindication) | Doc med rsn no cst/ist rx | 2023 |
M1185 | Documentation of immune checkpoint inhibitor therapy not held and/or corticosteroids or immunosuppressants prescribed or administered was not performed, reason not given | Imm ckpt inhib not hld no rx | 2023 |
M1186 | Patients who have an order for or are receiving hospice or palliative care | Pt w/ rx for hspc/plltv care | 2023 |
M1187 | Patients with a diagnosis of end stage renal disease (esrd) | Pt w/ esrd | 2023 |
M1188 | Patients with a diagnosis of chronic kidney disease (ckd) stage 5 | Pt w/ ckd stg 5 | 2023 |
M1189 | Documentation of a kidney health evaluation defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) performed | Doc khe pef w/efgr/uacr | 2023 |
M1190 | Documentation of a kidney health evaluation was not performed or defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) | Doc khe not pef w/efgr/uacr | 2023 |
M1191 | Hospice services provided to patient any time during the measurement period | Hspc svc any time in meas pd | 2023 |
M1192 | Patients with an existing diagnosis of squamous cell carcinoma of the esophagus | Pt w/ dx sq cell ca of esoph | 2023 |
M1193 | Surgical pathology reports that contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both | Rpts w/ imp/con mmr/msi | 2023 |
M1194 | Documentation of medical reason(s) surgical pathology reports did not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both tests were not included (e.g., patient will not be treated with checkpoint inhibitor therapy, no residual carcinoma is present in the sample [tissue exhausted or status post neoadjuvant treatment], insufficient tumor for testing) | Med rsn no imp/con mmr/msi | 2023 |
M1195 | Surgical pathology reports that do not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both, reason not given | Rpt wo imp/con mmr/msi | 2023 |
M1196 | Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4 | Ixv nrs vrs iqa >=4 | 2023 |
M1197 | Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score | Isa reduced >=3 fr ixv | 2023 |
M1198 | Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter | Isa not red 3pts /no assess | 2023 |
M1199 | Patients receiving rrt | Pt rec'g rrt | 2023 |
M1200 | Ace inhibitor (ace-i) or arb therapy prescribed during the measurement period | Ace-i/arb rx | 2023 |
M1201 | Documentation of medical reason(s) for not prescribing ace inhibitor (ace-i) or arb therapy during the measurement period (e.g., pregnancy, history of angioedema to ace-i, other allergy to ace-i and arb, hyperkalemia or history of hyperkalemia while on ace-i or arb therapy, acute kidney injury due to ace-i or arb therapy), other medical reasons) | Med rsn no ace-i/arb rx | 2023 |
M1202 | Documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons) | Pt rsn no ace-i/arb rx | 2023 |
M1203 | Ace inhibitor or arb therapy not prescribed during the measurement period, reason not given | No rsn ace-i/arb rx | 2023 |
M1204 | Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4 | Ixv nrs vrs iqa >=4 | 2023 |
M1205 | Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score | Isa reduced >=3 | 2023 |
M1206 | Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter | Isa not red 3pts/no assess | 2023 |
M1207 | Patient is screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety | Pt scrn sdoh | 2023 |
M1208 | Patient is not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety | Pt no scrn sdoh | 2023 |
M1209 | At least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses | >=2 same hi-rsk med w/o diag | 2023 |
M1210 | At least two orders for high-risk medications from the same drug class, (table 4), not ordered | >=2 same meds tbl4 not ord | 2023 |
M1211 | Most recent glycemic status assessment (hba1c or gmi) level > 9.0% | Gsa level>9.0% | 2024 |
M1212 | Glycemic status assessment (hba1c or gmi) level is missing, or was not performed during the measurement period | Missing gsa not perf | 2024 |
M1213 | No history of spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) and present spirometry is >= 70% | No hx spiro prs spiro>=70% | 2024 |
M1214 | Spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and reviewed | Spiro results wth obs doc | 2024 |
M1215 | Documentation of medical reason(s) for not documenting and reviewing spirometry results (e.g., patients with dementia or tracheostomy) | Med rsn for no doc spiro | 2024 |
M1216 | No spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and/or no spirometry performed with results documented during the encounter | No spiro doc no res doc | 2024 |
M1217 | Documentation of system reason(s) for not documenting and reviewing spirometry results (e.g., spirometry equipment not available at the time of the encounter) | Sys rsn no doc spiro | 2024 |
M1218 | Patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing) | Pt copd symptoms | 2024 |
M1220 | Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; with evidence of retinopathy | Dre wth interp rtnopthy | 2024 |
M1221 | Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy | Dre w/o rtnopthy | 2024 |
M1222 | Glaucoma plan of care not documented, reason not otherwise specified | Glaucoma pln of care not doc | 2024 |
M1223 | Glaucoma plan of care documented | Glaucoma plan of care doc | 2024 |
M1224 | Intraocular pressure (iop) reduced by a value less than 20% from the pre-intervention level | Iop dec <20% from base | 2024 |
M1225 | Intraocular pressure (iop) reduced by a value of greater than or equal to 20% from the pre-intervention level | Iop dec>=20% from base | 2024 |
M1226 | Iop measurement not documented, reason not otherwise specified | Iop not doc | 2024 |
M1227 | Evidence-based therapy was prescribed | Eb therapy prescribed | 2024 |
M1228 | Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, has hcv treatment initiated within 3 months of the reactive hcv antibody test | Pt + hcv aby +vir w/ rx 3 mo | 2024 |
M1229 | Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, is referred within 1 month of the reactive hcv antibody test to a clinician who treats hcv infection | Pt w/ +hcv +vir ref win 1 mo | 2024 |
M1230 | Patient has a reactive hcv antibody test and does not have a follow up hcv viral test, or patient has a reactive hcv antibody test and has a follow up hcv viral test that detects hcv viremia and is not referred to a clinician who treats hcv infection within 1 month and does not have hcv treatment initiated within 3 months of the reactive hcv antibody test, reason not given | Pt hcv rctv aby no f/u tst | 2024 |
M1231 | Patient receives hcv antibody test with nonreactive result | Pt hcv tst no reactive res | 2024 |
M1232 | Patient receives hcv antibody test with reactive result | Pt hcv tst reactive result | 2024 |
M1233 | Patient does not receive hcv antibody test or patient does receive hcv antibody test but results not documented, reason not given | Pt no hcv aby or result | 2024 |
M1234 | Patient has a reactive hcv antibody test, and has a follow up hcv viral test that does not detect hcv viremia | Pt hcv rctv aby f/u neg | 2024 |
M1235 | Documentation or patient report of hcv antibody test or hcv rna test which occurred prior to the performance period | Doc pt hcv aby rna tst | 2024 |
M1236 | Baseline mrs > 2 | Baseline mrs > 2 | 2024 |
M1237 | Patient reason for not screening for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety (e.g., patient declined or other patient reasons) | Pt rsn no scrn | 2024 |
M1238 | Documentation that administration of second recombinant zoster vaccine could not occur during the performance period due to the recommended 2-6 month interval between doses (i.e, first dose received after october 31) | Doc 2nd recom hzv 2-6 mo int | 2024 |
M1239 | Patient did not respond to the question of patient felt heard and understood by this provider and team | Pt no resp heard | 2024 |
M1240 | Patient did not respond to the question of patient felt this provider and team put my best interests first when making recommendations about my care | Pt no resp best int | 2024 |
M1241 | Patient did not respond to the question of patient felt this provider and team saw me as a person, not just someone with a medical problem | Pt no resp seen as person | 2024 |
M1242 | Patient did not respond to the question of patient felt this provider and team understood what is important to me in my life | Pt no resp imprt to me | 2024 |
M1243 | Patient provided a response other than "completely true" for the question of patient felt heard and understood by this provider and team | Pt othr thn true heard | 2024 |
M1244 | Patient provided a response other than "completely true" for the question of patient felt this provider and team put my best interests first when making recommendations about my care | Pt othr thn true best int | 2024 |
M1245 | Patient provided a response other than "completely true" for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem | Pt othr thn true person | 2024 |
M1246 | Patient provided a response other than "completely true" for the question of patient felt this provider and team understood what is important to me in my life | Pt othr thn true imprt to me | 2024 |
M1247 | Patient responded "completely true" for the question of patient felt this provider and team put my best interests first when making recommendations about my care | Pt resp true best int | 2024 |
M1248 | Patient responded "completely true" for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem | Pt resp true seen as person | 2024 |
M1249 | Patient responded "completely true" for the question of patient felt this provider and team understood what is important to me in my life | Pt resp true imprt to me | 2024 |
M1250 | Patient responded as "completely true" for the question of patient felt heard and understood by this provider and team | Pt resp true heard | 2024 |
M1251 | Patients for whom a proxy completed the entire hu survey on their behalf for any reason (no patient involvement) | Pts proxy cmplt hu surv | 2024 |
M1252 | Patients who did not complete at least one of the four patient experience hu survey items and return the hu survey within 60 days of the ambulatory palliative care visit | Pts no cmplt hu survey | 2024 |
M1253 | Patients who respond on the patient experience hu survey that they did not receive care by the listed ambulatory palliative care provider in the last 60 days (disavowal) | Pts hu surv no amb plltv | 2024 |
M1254 | Patients who were deceased when the hu survey reached them | Pts deceased prior hu surv | 2024 |
M1255 | Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere) | Pts w/ othr rsn vst,+prg tst | 2024 |
M1256 | Prior history of known cvd | Prior history of known cvd | 2024 |
M1257 | Cvd risk assessment not performed or incomplete (e.g., cvd risk assessment was not documented), reason not otherwise specified | Cvd risk assess not perf | 2024 |
M1258 | Cvd risk assessment performed, have a documented calculated risk score | Cvd risk assess perf | 2024 |
M1259 | Patient status documented within the first year of initiating dialysis | Pt stat doc <= 1 yr dialysis | 2024 |
M1260 | Patient status not documented within the first year of initiating dialysis | Pt not doc <= 1 yr dialysis | 2024 |
M1261 | Patients that were on the kidney or kidney-pancreas waitlist prior to initiation of dialysis | Pts on wtlist bef dialysis | 2024 |
M1262 | Patients who had a transplant prior to initiation of dialysis | Pts transplt bef dialysis | 2024 |
M1263 | Patients in hospice on their initiation of dialysis date or during the month of evaluation | Pts hosp dialysis dt | 2024 |
M1265 | Cms medical evidence form 2728 for dialysis patients: initial form completed | Cms 2728 completed | 2024 |
M1266 | Patients admitted to a skilled nursing facility (snf) | Pts admit snf | 2024 |
M1267 | Patients not observed in active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period | Pt no act kid transplt wtlst | 2024 |
M1268 | Patients observed in active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period | Pt ac stat kid trnsplt wtlst | 2024 |
M1269 | Receiving esrd mcp dialysis services by the provider on the last day of the reporting month | Rec'd esrd mcp lst day of mo | 2024 |
M1270 | Patients not on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period | Pts no kid transplt wtlst | 2024 |
M1271 | Patients with dementia at any time prior to or during the month | Pts dem any time/dur mo | 2024 |
M1272 | Patients observed on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period | Pts kid transplt wtlst | 2024 |
M1273 | Patients who were admitted to a skilled nursing facility (snf) within one year of dialysis initiation according to the cms-2728 form | Pts snf 1 yr dialysis | 2024 |
M1274 | Patients who were admitted to a skilled nursing facility (snf) during the month of evaluation were excluded from that month | Pts snf exl mo | 2024 |
M1275 | Patients determined to be in hospice were excluded from month of evaluation and the remainder of reporting period | Pts hosp exl | 2024 |
M1276 | Bmi documented outside normal parameters, no follow-up plan documented, no reason given | Calc bmi out nrm param nof/u | 2024 |
M1277 | Colorectal cancer screening results documented and reviewed | Colorectal ca screen doc rev | 2024 |
M1278 | Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented | Pre-htn or htn doc, f/u indc | 2024 |
M1279 | Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given | Pre-htn/htn, no f/u, not gvn | 2024 |
M1280 | Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy | Bilat mast/hx bi /unilat mas | 2024 |
M1281 | Blood pressure reading not documented, reason not given | Bp scrn no perf at interval | 2024 |
M1282 | Patient screened for tobacco use and identified as a tobacco non-user | Pt scrn tbco id as non user | 2024 |
M1283 | Patient screened for tobacco use and identified as a tobacco user | Pt scrn tbco and id as user | 2024 |
M1284 | Patients age 66 or older in institutional special needs plans (snp) or residing in long term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period | Pt 66+ snp or ltc pos > 90d | 2024 |
M1285 | Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified | Scrn mam perf rslts not doc | 2024 |
M1286 | Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason | Bmi doc onl fup not cmpltd | 2024 |
M1287 | Bmi is documented below normal parameters and a follow-up plan is documented | Calc bmi blw low param f/u | 2024 |
M1288 | Documented reason for not screening or recommending a follow-up for high blood pressure | Doc rsn no hbp scrn or f/u | 2024 |
M1289 | Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy) | No pt tbco cess interv rng | 2024 |
M1290 | Patient not eligible due to active diagnosis of hypertension | Pt not eli d/t act dig htn | 2024 |
M1291 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period | Pt 66+ frailty and med dem | 2024 |
M1292 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period | Pt 66+ frail inpt adv ill | 2024 |
M1293 | Bmi is documented above normal parameters and a follow-up plan is documented | Calc bmi abv up param f/u | 2024 |
M1294 | Normal blood pressure reading documented, follow-up not required | Bp scrn perf rec interval | 2024 |
M1295 | Patients with a diagnosis or past history of total colectomy or colorectal cancer | Pt hx tot col or colon ca | 2024 |
M1296 | Bmi is documented within normal parameters and no follow-up plan is required | Calc bmi norm parameters | 2024 |
M1297 | Bmi not documented due to medical reason or patient refusal of height or weight measurement | Bmi not doc medrsn ptref | 2024 |
M1298 | Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter | Doc pt preg dur msrmt pd | 2024 |
M1299 | Influenza immunization administered or previously received | Flu immunize order/admin | 2024 |
M1300 | Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) | Flu imm no admin doc rea | 2024 |
M1301 | Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy) | Pt recv tbco cess interv | 2024 |
M1302 | Screening, diagnostic, film digital or digital breast tomosynthesis (3d) mammography results documented and reviewed | Scrn mam perf rslts doc | 2024 |
M1303 | Hospice services provided to patient any time during the measurement period | Hospc serv dur meas pd | 2024 |
M1304 | Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period | No pneum vax admin 19+ | 2024 |
M1305 | Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period | Pneum vax admin 19+ | 2024 |
M1306 | Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period | Pt anphx due to pneum | 2024 |
M1307 | Documentation stating the patient has received or is currently receiving palliative or hospice care | Doc pt pal or hospice | 2024 |
M1308 | Influenza immunization was not administered, reason not given | Flu immunize no admin | 2024 |
M1309 | Palliative care services provided to patient any time during the measurement period | Pall serv during meas | 2024 |
M1310 | Patient screened for tobacco use and received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling, pharmacotherapy, or both), if identified as a tobacco user | Pt scr tob & cess int | 2024 |
M1311 | Anaphylaxis due to the vaccine on or before the date of the encounter | Aphlx to vax bef enc | 2024 |
M1312 | Patient not screened for tobacco use | No pt tbco scrn rng | 2024 |
M1313 | Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period | No tob scr/cess int | 2024 |
M1314 | Bmi not documented and no reason is given | Bmi not calculated | 2024 |
M1315 | Colorectal cancer screening results were not documented and reviewed; reason not otherwise specified | Crc no doc no rsn | 2024 |
M1316 | Current tobacco non-user | Tobacco non-user | 2024 |
M1317 | Patients who are counseled on connection with a csp and explicitly opt out | Pts counsl cpt opt out | 2024 |
M1318 | Patients who did not have documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening or documentation that there was no contact with a csp | Pts no csp doc contact | 2024 |
M1319 | Patients who had documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening | Pts csp doc contact | 2024 |
M1320 | Patients who screened positive for at least 1 of the 5 hrsns | Pts scrn + hrsn | 2024 |
M1321 | Patients who were not seen within 7 weeks following the date of injection for follow up or who did not have a documented iop or no plan of care documented if the iop was >25 mm hg | Pts no 7wk inj,no iop,iop>25 | 2024 |
M1322 | Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with documented iop =<25 mm hg for injected eye | Pts 7wk inj, scrn iop =<25 | 2024 |
M1323 | Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with documented iop >25 mm hg and a plan of care was documented | Pts 7wk inj, scrn iop >25 | 2024 |
M1324 | Patients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, dexamethasone intravitreal implant, or fluocinolone intravitreal implant) | Pts intravitreal/pci | 2024 |
M1325 | Patients who were not seen for reasons documented by clinician for patient or medical reasons (e.g., inadequate time for follow-up, patients who received a prior intravitreal or periocular steroid injection within the last six (6) months and had a subsequent iop evaluation with iop <25mm hg within seven (7) weeks of treatment) | Doc med rsn not seen | 2024 |
M1326 | Patients with a diagnosis of hypotony | Pts dx hypotony | 2024 |
M1327 | Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 8 weeks | Pts no eval ini xm no 8 wks | 2024 |
M1328 | Patients with a diagnosis of acute vitreous hemorrhage | Pts dx acute vitreous hem | 2024 |
M1329 | Patients with a post-operative encounter of the eye with the acute pvd within 2 weeks before the initial encounter or 8 weeks after initial acute pvd encounter | Pts act pvd 2 wks 8 wks | 2024 |
M1330 | Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up) | Doc pts rsn no f/u xm | 2024 |
M1331 | Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 8 weeks from initial exam | Pts eval ini xm 8 wks | 2024 |
M1332 | Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 2 weeks | Pts no eval ini xm no 2 wks | 2024 |
M1333 | Acute vitreous hemorrhage | Acute vitreous hemorrhage | 2024 |
M1334 | Patients with a post-operative encounter of the eye with the acute pvd within 2 weeks before the initial encounter or 2 weeks after initial acute pvd encounter | Pts act pvd 2 wks 2 wks | 2024 |
M1335 | Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up) | Doc pts rsn no f/u xm | 2024 |
M1336 | Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 2 weeks | Pts eval ini xm 2 wks | 2024 |
M1337 | Acute pvd | Acute pvd | 2024 |
M1338 | Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores during the performance period | Pt f/u 30-180 dys no + imprv | 2024 |
M1339 | Patients who had follow-up assessment 30 to 180 days after the index assessment who demonstrated positive improvement or maintenance of functioning scores during the performance period | Pts f/u 30-180 dys + improv | 2024 |
M1340 | Index assessment completed using the 12-item whodas 2.0 or sds during the denominator identification period | Indx whodas 2.0 or sds | 2024 |
M1341 | Patients who did not have a follow-up assessment or did not have an assessment within 30 to 180 days after the index assessment during the performance period | Pt no f/u 30-180 dys | 2024 |
M1342 | Patients who died during the performance period | Pts died perf per | 2024 |
M1343 | Patients who are at pam level 4 at baseline or patients who are flagged with extreme straight line response sets on the pam or with excessive missing responses | Pt pam lvl 4 base or srt lin | 2024 |
M1344 | Patients who did not have a baseline pam score and/or a second score within 4 to 12 months of baseline pam score | No bsln/2nd pam score 4-12mo | 2024 |
M1345 | Patients who had a baseline pam score and a second score within 4 to 12 month of baseline pam score | Pt bsln pam, 2nd scr 4-12 mo | 2024 |
M1346 | Patients who did not have a net increase in pam score of at least 6 points within a 4 to 12 month period | No pam inc 6 pts 4-12 mo | 2024 |
M1347 | Patients who achieved a net increase in pam score of at least 3 points in a 4 to 12 month period (passing) | Pt pam incr 3 pt 4-12 mo | 2024 |
M1348 | Patients who achieved a net increase in pam score of at least 6-points in a 4 to 12 month period (excellent) | Pam incr 6 pt 4-12 mo | 2024 |
M1349 | Patients who did not have a net increase in pam score of at least 3 points within a 4 to 12 month period | No pam inc 3 pts 4-12 mo | 2024 |
M1350 | Patients who had a completed suicide safety plan initiated, reviewed or updated in collaboration with their clinician (concurrent or within 24 hours) of the index clinical encounter | Pt w/ suic saf pln init rev | 2024 |
M1351 | Patients who had a suicide safety plan initiated, reviewed, or updated and reviewed and updated in collaboration with the patient and their clinician concurrent or within 24 hours of clinical encounter and within 120 days after initiation | Pt cmplt suicd saf pln 120dy | 2024 |
M1352 | Suicidal ideation and/or behavior symptoms based on the c-ssrs or equivalent assessment | Suicd c-ssrs assessment, equ | 2024 |
M1353 | Patients who did not have a completed suicide safety plan initiated, reviewed or updated in collaboration with their clinician (concurrent or within 24 hours) of the index clinical encounter | Pts no cmplt suicd saf pln | 2024 |
M1354 | Patients who did not have a suicide safety plan initiated, reviewed, or updated or reviewed and updated in collaboration with the patient and their clinician concurrent or within 24 hours of clinical encounter and within 120 days after initiation | Pt no suicd saf pln 120dy | 2024 |
M1355 | Suicide risk based on their clinician's evaluation or a clinician-rated tool | Suicd based cln eval | 2024 |
M1356 | Patients who died during the measurement period | Pt died dur meas pd | 2024 |
M1357 | Patients who had a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment | Pt w/red suic idea 120 days | 2024 |
M1358 | Patients who did not have a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment | Pts no <suicd idea 120 dys | 2024 |
M1359 | Index assessment during the denominator period when the suicidal ideation and/or behavior symptoms or increased suicide risk by clinician determination occurs and a non-zero c-ssrs score is obtained | Indx suicd idea, no 0 scr | 2024 |
M1360 | Suicidal ideation and/or behavior symptoms based on the c-ssrs | Suicd c-ssrs assessment | 2024 |
M1361 | Suicide risk based on their clinician's evaluation or a clinician-rated tool | Suicd based cln eval | 2024 |
M1362 | Patients who died during the measurement period | Pt died dur meas pd | 2024 |
M1363 | Patients who did not have a follow-up assessment within 120 days of the index assessment | Pts no f/u 120 dys | 2024 |
M1364 | Calculated 10-year ascvd risk score of >= 20 percent during the performance period | Ascvd risk >=20pct | 2024 |
M1365 | Patient encounter during the performance period with hospice and palliative care specialty code 17 | Hosp+pall care spec code 17 | 2024 |
M1366 | Focusing on women's health mips value pathway | Focus on women's health mvp | 2024 |
M1367 | Quality care for the treatment of ear, nose, and throat disorders mips value pathway | Qual care ent disorder mvp | 2024 |
M1368 | Prevention and treatment of infectious disorders including hepatitis c and hiv mips value pathway | Prev trt inf d/o hiv/hep mvp | 2024 |
M1369 | Quality care in mental health and substance use disorders mips value pathway | Qualcare mental hlth/sud mvp | 2024 |
M1370 | Rehabilitative support for musculoskeletal care mips value pathway | Rehab support msk care mvp | 2024 |
M1371 | Most recent glycemic status assessment (hba1c or gmi) level < 7.0% | Mst rec gsa<7 | 2025 |
M1372 | Most recent glycemic status assessment (hba1c or gmi) level >= 7.0% and < 8.0% | Mst rec gsa >=7 and<8 | 2025 |
M1373 | Most recent glycemic status assessment (hba1c or gmi) level >= 8.0% and <= 9.0% | Mst rec gsa >=8 and <=9 | 2025 |
M1374 | An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period | Ra dx enc 90 days dur per pd | 2025 |
M1375 | An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period | Ra dx enc 90 days dur per pd | 2025 |
M1376 | An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period | Ra dx enc 90 days dur per pd | 2025 |
M1377 | Recommended follow-up interval for repeat colonoscopy of 10 years documented in colonoscopy report and communicated with patient | Fu colscop 10 yr doc w/ disc | 2025 |
M1378 | Documentation of medical reason(s) for not recommending a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is >= 66 years old, or life expectancy < 10 years, other medical reasons) | Med rsn no 10 yr fu colscope | 2025 |
M1379 | A 10 year follow-up interval for colonoscopy not recommended, reason not otherwise specified | 10 yr fu no rec rsn not giv | 2025 |
M1380 | Filled at least two prescriptions during the performance period for any combination of the qualifying oral antipsychotic medications listed under "denominator note" or the long-acting injectable antipsychotic medications listed under "denominator note" | 2 rx in perf pd any com meds | 2025 |
M1381 | Patients with secondary stroke (e.g., a subsequent stroke that may occur with vasospasm in the setting of subarachnoid hemorrhage) within 5 days of the initial procedure | Pt sec strk wthin 5 days | 2025 |
M1382 | Patient encounter during the performance period with place of service code 11 | Enc dur perf pd pos 11 | 2025 |
M1383 | Acute pvd | Acute pvd | 2025 |
M1384 | Patients who died during the performance period | Pt died dur perf pd | 2025 |
M1385 | Documentation of patient reasons for patients who were not seen for the second pam survey (e.g., less than four months between baseline pam assessment and follow-up | Pt rsn not seen 2nd pam | 2025 |
M1386 | Patients with an excisional surgery for melanoma or melanoma in situ in the past 5 years with an initial ajcc staging of 0, i, or ii at the start of the performance period | Exc sx melmn or mlnm is | 2025 |
M1387 | Patients who died during the performance period | Pt died dur perf pd | 2025 |
M1388 | Patients with documentation of an exam performed for recurrence of melanoma | Pt doc exm rec melmn | 2025 |
M1390 | Patients who do not have a documented exam performed for recurrence of melanoma or no documentation within the performance period | Pt no doc exm for rec | 2025 |
M1391 | All patients who were diagnosed with recurrent melanoma during the current performance period | All pt dx w/ rec mlnm | 2025 |
M1392 | Documentation of patient reasons for no examination, i.e., refusal of examination or lost to follow-up (documentation must include information that the clinician was unable to reach the patient by phone, mail or secure electronic mail - at least one method must be documented) | Pt rsn no exm or lst to fu | 2025 |
M1393 | Patients who were not diagnosed with recurrent melanoma during the current performance period | Pr no dx rec mlnm | 2025 |
M1394 | Stages i-iii breast cancer | Stg i-iii br ca | 2025 |
M1395 | Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group | Init chemo w/def dur ec grp | 2025 |
M1396 | Patients on a therapeutic clinical trial | Pt ther clin trial | 2025 |
M1397 | Patients with recurrence/disease progression | Pt w/ recur/prog | 2025 |
M1398 | Patients with baseline and follow-up promis surveys documented in the medical record | Bslne and fu promis doc | 2025 |
M1399 | Patients who leave the practice during the follow-up period | Pt lve prac | 2025 |
M1400 | Patients who died during the follow-up period | Pt died dur perf pd | 2025 |
M1401 | Stages i-iii breast cancer | Stg i-iii br ca | 2025 |
M1402 | Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group | Init chemo w/def dur ec grp | 2025 |
M1403 | Patients with baseline and follow-up promis surveys documented in the medical record | Bslne and fu promis doc | 2025 |
M1404 | Patients on a therapeutic clinical trial | Pt ther clin trial | 2025 |
M1405 | Patients with recurrence/disease progression | Pt w/ recur/prog | 2025 |
M1406 | Patients who leave the practice during the follow-up period | Pt lve prac | 2025 |
M1407 | Patients who died during the follow-up period | Pt died dur perf pd | 2025 |
M1408 | Patients who have germline brca testing completed before diagnosis of epithelial ovarian, fallopian tube, or primary peritoneal cancer | Gmln brca bef dx ca | 2025 |
M1409 | Patients who received germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis | Recd gmln brca1/brca2 couns | 2025 |
M1410 | Patients who did not have germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis | No gmln brca1/brca2 couns | 2025 |
M1411 | Currently on first-line immune checkpoint inhibitors without chemotherapy | 1st ln ici no chemo | 2025 |
M1412 | Patients with metastatic nsclc with epidermal growth factor receptor (egfr) mutations, alk genomic tumor aberrations, or other targetable genomic abnormalities with approved first-line targeted therapy, such as nsclc with ros1 rearrangement, braf v600e mutation, ntrk 1/2/3 gene fusion, met ex14 skipping mutation, and ret rearrangement | Met nsclc w/ egfr alk oth ab | 2025 |
M1413 | Patients who had a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy | Pos pdl1 bef init ici tx | 2025 |
M1414 | Documentation of medical reason(s) for not performing the pd-l1 biomarker expression test prior to initiation of first-line immune checkpoint inhibitor therapy (e.g., patient is in an urgent or emergent situation where delay of treatment would jeopardize the patient's health status; other medical reasons/contraindication) | Med rsn no pdl1 bef 1st ther | 2025 |
M1415 | Patients who did not have a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy | No pos pdl1 bef ici ther | 2025 |
M1416 | Patient received hospice services any time during the performance period | Pt rec hosp | 2025 |
M1417 | Patients who are up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination | Pt up to date cov | 2025 |
M1418 | Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination because of a medical contraindication documented by clinician | Med rsn not up to date cov | 2025 |
M1419 | Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination | Pt not up to date cov | 2025 |
M1420 | Complete ophthalmologic care mips value pathway | Complete ophthalmologic mvp | 2025 |
M1421 | Dermatological care mips value pathway | Dermatological care mvp | 2025 |
M1422 | Gastroenterology care mips value pathway | Gastroenterology care mvp | 2025 |
M1423 | Optimal care for patients with urologic conditions mips value pathway | Opt care urologic cnd mvp | 2025 |
M1424 | Pulmonology care mips value pathway | Pulmonology care mvp | 2025 |
M1425 | Surgical care mips value pathway | Surgical care mvp | 2025 |
M1426 | Encounters conducted via telehealth | Telehealth enc | 2026 |
M1427 | Documentation of medical reason(s) for performing a bone scan (including documented pain related to prostate cancer, salvage therapy, other medical reasons) | Doc med rsn bone scn | 2026 |
M1428 | Patients who have bilateral absence of eyes any time during the patient's history through the end of the measurement period | Bilateral absence of eyes | 2026 |
M1429 | Retinal exam finding with evidence of retinopathy in left, right or both eyes with severity level documented | Retinopathy in od, os, ou | 2026 |
M1430 | Retinal exam finding without evidence of retinopathy in both eyes with severity level documented (in measurement year or in the prior year) | Ret exm ou no retinopthy doc | 2026 |
M1431 | Encounters conducted via telehealth | Telehealth enc | 2026 |
M1432 | Encounters conducted via telehealth | Telehealth enc | 2026 |
M1433 | Patient on oral chemotherapy on or within 30 days before denominator eligible encounter | Oral chemo wthn 30 days enc | 2026 |
M1434 | Patient on oral chemotherapy on or within 30 days after denominator eligible encounter | Orl chemo wthn 30 d post enc | 2026 |
M1435 | Patient on oral chemotherapy during the performance period | Oral chemo in perf pd | 2026 |
M1436 | Encounters conducted via telehealth | Telehealth enc | 2026 |
M1437 | Encounters conducted via telehealth | Telehealth enc | 2026 |
M1438 | Time last known well to hospital arrival less than or equal to 3.5 hours (<= 210 minutes) | Lst knwn well <=210 min | 2026 |
M1439 | Significant ocular conditions that impact the visual outcome of surgery | Sig ocu cond imp surg out | 2026 |
M1440 | Encounters conducted via telehealth | Telehealth enc | 2026 |
M1441 | Encounter corresponds to initial diagnosis of sleep apnea or first contact with sleep apnea diagnosed patient | Init dx slp apn = 1st enc | 2026 |
M1442 | Encounters conducted via telehealth | Telehealth enc | 2026 |
M1443 | Encounters conducted via telehealth | Telehealth enc | 2026 |
M1444 | Delivery at < 39 weeks of gestation | Del < 39 weeks gest | 2026 |
M1445 | Postpartum care visit before or at 12 weeks of giving birth | Pp care visit by 12 weeks | 2026 |
M1446 | Patients who died any time prior to the end of the measure assessment period | Pt died bef end meas pd | 2026 |
M1447 | Patients with an active diagnosis of bipolar disorder any time prior to the end of the measure assessment period | Pt dx bd bef end meas pd | 2026 |
M1448 | Patients with an active diagnosis of personality disorder any time prior to the end of the measure assessment period | Pt dx pd bef end meas pd | 2026 |
M1449 | Patients with an active diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period | Pt dx scz/pys bef end msr pd | 2026 |
M1450 | Patients who received hospice or palliative care service any time during denominator identification period or the measure assessment period | Pt hos/pal care dur id/pf pd | 2026 |
M1451 | Patients with an active diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period | Pt dx ppd dur id/pf pd | 2026 |
M1452 | Patient ever had a diagnosis of dementia | Pt dx dementia ever | 2026 |
M1453 | Patients with a pre-operative visual acuity better than 20/40 | Preop vis acu > 20/40 | 2026 |
M1454 | New cied | New cied | 2026 |
M1455 | Replaced or revised cied | Rep/rev cied | 2026 |
M1456 | Patient had a heart transplant | Pt had htx | 2026 |
M1457 | Patient had a diagnosis of asthma with any contact during the current or prior performance period or had asthma present on an active problem list any time during the performance period | Dx asth dur crnt/prv perf pd | 2026 |
M1458 | Patient died prior to the end of the performance period | Pt died bef end meas pd | 2026 |
M1459 | Patient was in hospice or receiving palliative care services at any time during the performance period | Pt hosp/pal care dur perf pd | 2026 |
M1460 | Diagnosis for chronic obstructive pulmonary disease, emphysema, cystic fibrosis, or acute respiratory failure | Dx copd, cf, or arf | 2026 |
M1461 | Patient diagnosis for chronic hepatitis c | Pt dx chron hepc | 2026 |
M1462 | Patients with clinical indications for imaging of the head | Pt clin ind hd image | 2026 |
M1463 | Documentation of at least two attempts to follow up with patient within 180 days of treatment | 2 f/u wthn 180 day rx atmp | 2026 |
M1464 | No documentation of at least two attempts to follow up with patient within 180 days of treatment | No record of f/u by 180 days | 2026 |
M1465 | Patient follow up more than 180 days after treatment | F/u > 180 days after rx | 2026 |
M1466 | Patient had a lumbar fusion on the same date as the discectomy/laminectomy procedure | Pt disc/lam proc same day | 2026 |
M1467 | Patients with an existing diagnosis of lynch syndrome | Pt dx lynch syn | 2026 |
M1468 | Patient received recommended doses of hepatitis b vaccination based on age | Hep b vaccine received | 2026 |
M1469 | Patient has a history of hepatitis b illness or received a hepatitis b surface antigen, hepatitis b surface antibody, or total antibody to hepatitis b core antigen test with a positive result any time before or during the measurement period | Hx of hep b, or pos bld test | 2026 |
M1470 | Documentation of medical reason(s) for not administering hepatitis b vaccine (e.g., prior anaphylaxis due to the hepatitis b vaccine) | Hep b vac not rec'd med rsn | 2026 |
M1471 | Documentation that patient is a medicare fee-for-service beneficiary and without additional supplementary insurance coverage for whom hep b vaccination is not reimbursable under current medicare part b coverage rules | Ffs hep b not covered | 2026 |
M1472 | Patient did not receive recommended doses of hepatitis b vaccination based on age | Hep b vaccine not received | 2026 |
M1473 | Patient situations, at any point during the denominator identification period, where the patient's functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools, such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders | Pt func cap not allow impr | 2026 |
M1474 | Patients with diagnosis of dementia | Pt dx dementia | 2026 |
M1475 | Patients with diagnosis of huntington's disease | Pt dx huntington | 2026 |
M1476 | Patients with diagnosis of cognitive impairment or alzheimer's disease | Pt dx cog imp or ad | 2026 |
M1477 | Diagnosis of delirium | Dx delirium | 2026 |
M1478 | Psychoactive substance abuse | Psychoactive sub abuse | 2026 |
M1479 | Patients whose functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders | Pt func cap not allow impr | 2026 |
M1480 | Patients whose functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders | Pt func cap not allow impr | 2026 |
M1481 | Patients receiving hospice or palliative care or who died during the measurement period | Pt in hosp/pal care who died | 2026 |
M1482 | Positive/detectable hepatitis c virus quantitative or qualitative rna test result during the denominator identification period | Pos quan hep c or qual rna | 2026 |
M1483 | Patients who achieve sustained virological response as identified by an hcv rna test (cpt 87522) or (cpt 87521) with a negative/undetectable hcv rna result that occurred 20 weeks to 12 months after the first positive/detectable hcv rna test result within the denominator identification period | Neg quan hep c or qual rna | 2026 |
M1484 | Patients who did not have a repeat hcv rna labs performed for medical reasons documented by clinician (e.g., patient with limited life expectancy, delay in treatment of hcv related to treatment of hiv, hbv, hepatocellular carcinoma, decompensated cirrhosis) | No rpt hcv rna perf med rsn | 2026 |
M1485 | Patients who did not achieve sustained virological response as identified by an hcv rna test (cpt 87522) or (cpt 87521) with a negative/undetectable hcv rna result that occurred 20 weeks to 12 months after the first positive/detectable hcv rna test result within the denominator identification period | Neg viro resp hep c/qual rna | 2026 |
M1486 | Patients admitted to a skilled nursing facility (snf) during the period of evaluation | Pt admitted to snf dur eval | 2026 |
M1487 | Patients in hospice in the year before or during the period of evaluation | Pt adm to hospice dur eval | 2026 |
M1488 | Patients with a diagnosis for dementia in the year before or during the period of evaluation | Dx dementia in msr timeframe | 2026 |
M1489 | Patient status documented | Pt status doc | 2026 |
M1490 | Patient status not documented | Pt status not doc | 2026 |
M1491 | Receiving esrd mcp dialysis services by the provider during the performance period | Rec'd esrd mcp dur perf pd | 2026 |
M1492 | Patients who did not report a fall | No reported fall | 2026 |
M1493 | Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy) | No fall doc med rsn | 2026 |
M1494 | Patients that reported a fall since the last visit | Fall rep since last visit | 2026 |
M1495 | Patients that reported a fall occurred who had a plan of care for falls documented or patients that did not report a fall | Fall w/ poc, no fall | 2026 |
M1496 | Patients that had a fall who did not have a plan of care for falls documented or do not have documentation of being assessed for falls | No doc of fall or poc | 2026 |
M1497 | Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy) | No doc fall med rsn | 2026 |
M1498 | Diagnostic radiology mips value pathway | Diagnostic radiology mvp | 2026 |
M1499 | Interventional radiology mips value pathway | Interventional radiology mvp | 2026 |
M1500 | Neuropsychology mips value pathway | Neuropsychology mvp | 2026 |
M1501 | Pathology mips value pathway | Pathology mvp | 2026 |
M1502 | Podiatry mips value pathway | Podiatry mvp | 2026 |
M1503 | Vascular surgery mips value pathway | Vascular surgery mvp | 2026 |
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