M-code: Medical services and quality measures Medical services and quality measures
506 codes
Billing context
M-codes describe certain medical services and quality-measure reporting.
| Code | Long descriptor | Payment limit (Q4 2026) | Added | Status |
|---|---|---|---|---|
| M0001 | Advancing cancer care mips value pathways | — | Jan 1, 2023 | Active |
| M0002 | Optimal care for kidney health mips value pathways | — | Jan 1, 2023 | Active |
| M0003 | Optimal care for patients with episodic neurological conditions mips value pathways | — | Jan 1, 2023 | Ended Dec 31, 2024 |
| M0004 | Quality care for patients with neurological conditions mips value pathway | — | Jan 1, 2023 | Active |
| M0005 | Value in primary care mips value pathway | — | Jan 1, 2023 | Active |
| M0010 | Enhancing oncology model (eom) monthly enhanced oncology services (meos) payment for eom enhanced services | — | Apr 1, 2023 | Active |
| M0064 | Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders | — | Jan 1, 1992 | Ended Dec 31, 2014 |
| M0075 | Cellular therapy | — | Jan 1, 1986 | Active |
| M0076 | Prolotherapy | — | Jan 1, 1986 | Active |
| M0100 | Intragastric hypothermia using gastric freezing | — | Jan 1, 1986 | Active |
| 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 | — | Jun 8, 2021 | Active |
| M0220 | Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring | — | Dec 8, 2021 | Ended Dec 12, 2024 |
| M0221 | Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency | — | Dec 8, 2021 | Ended Dec 12, 2024 |
| M0222 | Intravenous injection, bebtelovimab, includes injection and post administration monitoring | — | Feb 11, 2022 | Ended Dec 12, 2024 |
| M0223 | Intravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency | — | Feb 11, 2022 | Ended Dec 12, 2024 |
| 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 | — | Mar 22, 2024 | Active |
| 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 | — | Jul 1, 2026 | Active |
| 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 | — | Jul 1, 2026 | Active |
| 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 | — | Apr 1, 2026 | Active |
| 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 | — | Apr 1, 2026 | Active |
| 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 | — | Oct 1, 2025 | Active |
| 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 | — | Oct 1, 2025 | Active |
| 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 | — | Jan 24, 2025 | Active |
| 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 | — | Jan 24, 2025 | Active |
| M0239 | Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring | — | Nov 9, 2020 | Ended Apr 16, 2021 |
| M0240 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses | — | Jul 30, 2021 | Ended Dec 12, 2024 |
| M0241 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency, subsequent repeat doses | — | Jul 30, 2021 | Ended Dec 12, 2024 |
| M0243 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring | — | Nov 21, 2020 | Ended Dec 12, 2024 |
| M0244 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency | — | May 6, 2021 | Ended Dec 12, 2024 |
| M0245 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring | — | Feb 9, 2021 | Ended Dec 13, 2023 |
| M0246 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider based to the hospital during the covid 19 public health emergency | — | May 6, 2021 | Ended Dec 13, 2023 |
| M0247 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring | — | May 26, 2021 | Ended Dec 12, 2024 |
| M0248 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency | — | May 26, 2021 | Ended Dec 12, 2024 |
| 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 | — | Jun 24, 2021 | Active |
| 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 | — | Jun 24, 2021 | Active |
| M0300 | Iv chelation therapy (chemical endarterectomy) | — | Jan 1, 1986 | Active |
| M0301 | Fabric wrapping of abdominal aneurysm | — | Jan 1, 1986 | Active |
| M1000 | Pain screened as moderate to severe | — | Jan 1, 2019 | Ended Dec 31, 2019 |
| M1001 | Plan of care to address moderate to severe pain documented on or before the date of the second visit with a clinician | — | Jan 1, 2019 | Ended Dec 31, 2019 |
| M1002 | Plan of care for moderate to severe pain not documented on or before the date of the second visit with a clinician, reason not given | — | Jan 1, 2019 | Ended Dec 31, 2019 |
| M1003 | Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic and/or immune response modifier therapy | — | Jan 1, 2019 | Active |
| 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) | — | Jan 1, 2019 | Active |
| M1005 | Tb screening not performed or results not interpreted, reason not given | — | Jan 1, 2019 | Active |
| M1006 | Disease activity not assessed, reason not given | — | Jan 1, 2019 | Active |
| M1007 | >=50% of total number of a patient's outpatient ra encounters assessed | — | Jan 1, 2019 | Active |
| M1008 | <50% of total number of a patient's outpatient ra encounters assessed | — | Jan 1, 2019 | Active |
| M1009 | Discharge/discontinuation of the episode of care documented in the medical record | — | Jan 1, 2019 | Active |
| M1010 | Discharge/discontinuation of the episode of care documented in the medical record | — | Jan 1, 2019 | Active |
| M1011 | Discharge/discontinuation of the episode of care documented in the medical record | — | Jan 1, 2019 | Active |
| M1012 | Discharge/discontinuation of the episode of care documented in the medical record | — | Jan 1, 2019 | Active |
| M1013 | Discharge/discontinuation of the episode of care documented in the medical record | — | Jan 1, 2019 | Active |
| M1014 | Discharge/discontinuation of the episode of care documented in the medical record | — | Jan 1, 2019 | Active |
| M1015 | Discharge/discontinuation of the episode of care documented in the medical record | — | Jan 1, 2019 | Ended Dec 31, 2020 |
| M1016 | Female patients unable to bear children | — | Jan 1, 2019 | Active |
| M1017 | Patient admitted to palliative care services | — | Jan 1, 2019 | Ended Dec 31, 2022 |
| 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 | — | Jan 1, 2019 | Active |
| 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 | — | Jan 1, 2019 | Active |
| 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 | — | Jan 1, 2019 | Active |
| M1021 | Patient had only urgent care visits during the performance period | — | Jan 1, 2019 | Active |
| M1022 | Patients who were in hospice at any time during the performance period | — | Jan 1, 2019 | Ended Dec 31, 2021 |
| M1023 | Adolescent patients 12 to 17 years of age with major depression or dysthymia who reached remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five | — | Jan 1, 2019 | Ended Dec 31, 2020 |
| M1024 | Adolescent patients 12 to 17 years of age with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five. either phq-9 or phq-9m score was not assessed or is greater than or equal to five | — | Jan 1, 2019 | Ended Dec 31, 2020 |
| M1025 | Patients who were in hospice at any time during the performance period | — | Jan 1, 2019 | Ended Dec 31, 2021 |
| M1026 | Patients who were in hospice at any time during the performance period | — | Jan 1, 2019 | Ended Dec 31, 2021 |
| M1027 | Imaging of the head (ct or mri) was obtained | — | Jan 1, 2019 | Active |
| M1028 | Documentation of patients with primary headache diagnosis and imaging other than ct or mri obtained | — | Jan 1, 2019 | Active |
| M1029 | Imaging of the head (ct or mri) was not obtained, reason not given | — | Jan 1, 2019 | Active |
| M1030 | Patients with clinical indications for imaging of the head | — | Jan 1, 2019 | Ended Dec 31, 2019 |
| M1031 | Patients with no clinical indications for imaging of the head | — | Jan 1, 2019 | Ended Dec 31, 2021 |
| M1032 | Adults currently taking pharmacotherapy for oud | — | Jan 1, 2019 | Active |
| M1033 | Pharmacotherapy for oud initiated after june 30th of performance period | — | Jan 1, 2019 | Ended Dec 31, 2020 |
| 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 | — | Jan 1, 2019 | Active |
| M1035 | Adults who are deliberately phased out of medication assisted treatment (mat) prior to 180 days of continuous treatment | — | Jan 1, 2019 | Active |
| 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 | — | Jan 1, 2019 | Active |
| M1037 | Patients with a diagnosis of lumbar spine region cancer at the time of the procedure | — | Jan 1, 2019 | Active |
| M1038 | Patients with a diagnosis of lumbar spine region fracture at the time of the procedure | — | Jan 1, 2019 | Active |
| M1039 | Patients with a diagnosis of lumbar spine region infection at the time of the procedure | — | Jan 1, 2019 | Active |
| M1040 | Patients with a diagnosis of lumbar idiopathic or congenital scoliosis | — | Jan 1, 2019 | Active |
| M1041 | Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis | — | Jan 1, 2019 | Active |
| M1042 | Functional status measurement with score was obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively | — | Jan 1, 2019 | Ended Dec 31, 2019 |
| M1043 | Functional status was not measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively | — | Jan 1, 2019 | Active |
| M1044 | Functional status was measured by the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively | — | Jan 1, 2019 | Ended Dec 31, 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 | — | Jan 1, 2019 | Active |
| 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 | — | Jan 1, 2019 | Active |
| M1047 | Functional status was measured by the oxford knee score (oks) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively | — | Jan 1, 2019 | Ended Dec 31, 2019 |
| M1048 | Functional status measurement with score was obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at three months (6 to 20 weeks) postoperatively | — | Jan 1, 2019 | Ended Dec 31, 2019 |
| M1049 | Functional status was not measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively | — | Jan 1, 2019 | Active |
| M1050 | Functional status was measured by the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at three months (6 to 20 weeks) postoperatively | — | Jan 1, 2019 | Ended Dec 31, 2019 |
| M1051 | Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis | — | Jan 1, 2019 | Active |
| M1052 | Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively | — | Jan 1, 2019 | Active |
| M1053 | Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively | — | Jan 1, 2019 | Ended Dec 31, 2019 |
| M1054 | Patient had only urgent care visits during the performance period | — | Jan 1, 2019 | Active |
| M1055 | Aspirin or another antiplatelet therapy used | — | Jan 1, 2019 | Active |
| 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 | — | Jan 1, 2019 | Active |
| M1057 | Aspirin or another antiplatelet therapy not used, reason not given | — | Jan 1, 2019 | Active |
| M1058 | Patient was a permanent nursing home resident at any time during the performance period | — | Jan 1, 2019 | Active |
| M1059 | Patient was in hospice or receiving palliative care at any time during the performance period | — | Jan 1, 2019 | Active |
| M1060 | Patient died prior to the end of the performance period | — | Jan 1, 2019 | Active |
| M1061 | Patient pregnancy | — | Jan 1, 2019 | Ended Dec 31, 2020 |
| M1062 | Patient immunocompromised | — | Jan 1, 2019 | Ended Dec 31, 2020 |