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 |
|---|---|---|---|---|
| M1063 | Patients receiving high doses of immunosuppressive therapy | — | Jan 1, 2019 | Ended Dec 31, 2020 |
| M1064 | Shingrix vaccine documented as administered or previously received | — | Jan 1, 2019 | Ended Dec 31, 2020 |
| M1065 | Shingrix vaccine was not administered for reasons documented by clinician (e.g. patient administered vaccine other than shingrix, patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) | — | Jan 1, 2019 | Ended Dec 31, 2020 |
| M1066 | Shingrix vaccine not documented as administered, reason not given | — | Jan 1, 2019 | Ended Dec 31, 2020 |
| M1067 | Hospice services for patient provided any time during the measurement period | — | Jan 1, 2019 | Active |
| M1068 | Adults who are not ambulatory | — | Jan 1, 2019 | Active |
| M1069 | Patient screened for future fall risk | — | Jan 1, 2019 | Active |
| M1070 | Patient not screened for future fall risk, reason not given | — | Jan 1, 2019 | Active |
| M1071 | Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminotomy | — | Jan 1, 2019 | Ended Dec 31, 2022 |
| M1106 | The start of an episode of care documented in the medical record | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| M1110 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) | — | Jan 1, 2020 | Active |
| M1111 | The start of an episode of care documented in the medical record | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| M1115 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) | — | Jan 1, 2020 | Active |
| M1116 | The start of an episode of care documented in the medical record | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| M1120 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) | — | Jan 1, 2020 | Active |
| M1121 | The start of an episode of care documented in the medical record | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| M1125 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) | — | Jan 1, 2020 | Active |
| M1126 | The start of an episode of care documented in the medical record | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| M1130 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| 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 | — | Jan 1, 2020 | Active |
| M1134 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) | — | Jan 1, 2020 | Active |
| M1135 | The start of an episode of care documented in the medical record | — | Jan 1, 2020 | Active |
| M1136 | The start of an episode of care documented in the medical record | — | Jan 1, 2020 | Ended Dec 31, 2020 |
| M1137 | 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 | — | Jan 1, 2020 | Ended Dec 31, 2020 |
| M1138 | Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only) | — | Jan 1, 2020 | Ended Dec 31, 2020 |
| M1139 | Ongoing care not indicated, patient self-discharged early and seen only 1-2 visits (e.g., financial or insurance reasons, transportation problems, or reason unknown) | — | Jan 1, 2020 | Ended Dec 31, 2020 |
| M1140 | Ongoing care not indicated, patient discharged after only 1-2 visits due to specific medical events, documented in the medical record that make the treatment episode impossible such as the patient becomes hospitalized or scheduled for surgery for surgery or hospitalized | — | Jan 1, 2020 | Ended Dec 31, 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 | — | Jan 1, 2020 | Active |
| M1142 | Emergent cases | — | Jan 1, 2020 | Active |
| M1143 | Initiated episode of rehabilitation therapy, medical, or chiropractic care for neck impairment | — | Jan 1, 2020 | Active |
| M1144 | Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only | — | Jan 1, 2020 | Ended Dec 31, 2020 |
| M1145 | Most favored nation (mfn) model drug add-on amount, per dose, (do not bill with line items that have the jw modifier) | — | Jan 1, 2021 | Ended Feb 27, 2022 |
| 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 | — | Jan 1, 2021 | Active |
| 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 | — | Jan 1, 2021 | Active |
| M1148 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) | — | Jan 1, 2021 | Active |
| 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 | — | Jan 1, 2021 | Active |
| 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 | — | Jan 1, 2023 | Active |
| M1151 | Patients with a history of heart transplant or with a left ventricular assist device (lvad) | — | Jan 1, 2023 | Active |
| M1152 | Patients with a history of heart transplant or with a left ventricular assist device (lvad) | — | Jan 1, 2023 | Active |
| M1153 | Patient with diagnosis of osteoporosis on date of encounter | — | Jan 1, 2023 | Active |
| M1154 | Hospice services provided to patient any time during the measurement period | — | Jan 1, 2023 | Ended Dec 31, 2024 |
| M1155 | Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period | — | Jan 1, 2023 | Ended Dec 31, 2024 |
| M1156 | Patient received active chemotherapy any time during the measurement period | — | Jan 1, 2023 | Ended Dec 31, 2023 |
| M1157 | Patient received bone marrow transplant any time during the measurement period | — | Jan 1, 2023 | Ended Dec 31, 2023 |
| M1158 | Patient had history of immunocompromising conditions prior to or during the measurement period | — | Jan 1, 2023 | Ended Dec 31, 2023 |
| M1159 | Hospice services provided to patient any time during the measurement period | — | Jan 1, 2023 | Active |
| M1160 | Patient had anaphylaxis due to the meningococcal vaccine any time on or before the patient's 13th birthday | — | Jan 1, 2023 | Active |
| M1161 | Patient had anaphylaxis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday | — | Jan 1, 2023 | Active |
| M1162 | Patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday | — | Jan 1, 2023 | Active |
| M1163 | Patient had anaphylaxis due to the hpv vaccine any time on or before the patient's 13th birthday | — | Jan 1, 2023 | Active |
| M1164 | Patients with dementia any time during the patient's history through the end of the measurement period | — | Jan 1, 2023 | Active |
| M1165 | Patients who use hospice services any time during the measurement period | — | Jan 1, 2023 | Active |
| M1166 | Pathology report for tissue specimens produced from wide local excisions or re-excisions | — | Jan 1, 2023 | Active |
| M1167 | In hospice or using hospice services during the measurement period | — | Jan 1, 2023 | Active |
| 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 | — | Jan 1, 2023 | Active |
| M1169 | Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine) | — | Jan 1, 2023 | Active |
| 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 | — | Jan 1, 2023 | Active |
| 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 | — | Jan 1, 2023 | Active |
| 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) | — | Jan 1, 2023 | Active |
| 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 | — | Jan 1, 2023 | Active |
| 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 | — | Jan 1, 2023 | Active |
| M1175 | Documentation of medical reason(s) for not administering zoster vaccine (e.g., prior anaphylaxis due to the zoster vaccine) | — | Jan 1, 2023 | Active |
| 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 | — | Jan 1, 2023 | Active |
| M1177 | Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period | — | Jan 1, 2023 | Active |
| M1178 | Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., prior anaphylaxis due to the pneumococcal vaccine) | — | Jan 1, 2023 | Active |
| M1179 | Patient did not receive any pneumococcal conjugate or polysaccharide vaccine, on or after their 19th birthday and before or during measurement period | — | Jan 1, 2023 | Active |
| M1180 | Patients on immune checkpoint inhibitor therapy | — | Jan 1, 2023 | Active |
| M1181 | Grade 2 or above diarrhea and/or grade 2 or above colitis | — | Jan 1, 2023 | Active |
| M1182 | Patients not eligible due to pre-existing inflammatory bowel disease (ibd) (e.g., ulcerative colitis, crohn's disease) | — | Jan 1, 2023 | Active |
| M1183 | Documentation of immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered | — | Jan 1, 2023 | Active |
| 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) | — | Jan 1, 2023 | Active |
| M1185 | Documentation of immune checkpoint inhibitor therapy not held and/or corticosteroids or immunosuppressants prescribed or administered was not performed, reason not given | — | Jan 1, 2023 | Active |
| M1186 | Patients who have an order for or are receiving hospice or palliative care | — | Jan 1, 2023 | Active |
| M1187 | Patients with a diagnosis of end stage renal disease (esrd) | — | Jan 1, 2023 | Active |
| M1188 | Patients with a diagnosis of chronic kidney disease (ckd) stage 5 | — | Jan 1, 2023 | Active |
| M1189 | Documentation of a kidney health evaluation defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) performed | — | Jan 1, 2023 | Active |
| 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) | — | Jan 1, 2023 | Active |
| M1191 | Hospice services provided to patient any time during the measurement period | — | Jan 1, 2023 | Active |
| M1192 | Patients with an existing diagnosis of squamous cell carcinoma of the esophagus | — | Jan 1, 2023 | Active |
| 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 | — | Jan 1, 2023 | Active |
| 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) | — | Jan 1, 2023 | Active |
| 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 | — | Jan 1, 2023 | Active |
| M1196 | Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4 | — | Jan 1, 2023 | Active |