Skip to main content
CodeRx
Open menu
↑↓ move↵ open CodeRx

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.
M-codes, page 3 of 6
CodeLong descriptorPayment limit (Q4 2026)AddedStatus
M1197Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score—Jan 1, 2023Active
M1198Itch 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—Jan 1, 2023Active
M1199Patients receiving rrt—Jan 1, 2023Active
M1200Ace inhibitor (ace-i) or arb therapy prescribed during the measurement period—Jan 1, 2023Active
M1201Documentation 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)—Jan 1, 2023Active
M1202Documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons)—Jan 1, 2023Active
M1203Ace inhibitor or arb therapy not prescribed during the measurement period, reason not given—Jan 1, 2023Active
M1204Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4—Jan 1, 2023Active
M1205Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score—Jan 1, 2023Active
M1206Itch 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—Jan 1, 2023Active
M1207Patient is screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety—Jan 1, 2023Active
M1208Patient is not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety—Jan 1, 2023Active
M1209At least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses—Jan 1, 2023Active
M1210At least two orders for high-risk medications from the same drug class, (table 4), not ordered—Jan 1, 2023Active
M1211Most recent glycemic status assessment (hba1c or gmi) level > 9.0%—Jan 1, 2024Active
M1212Glycemic status assessment (hba1c or gmi) level is missing, or was not performed during the measurement period—Jan 1, 2024Active
M1213No history of spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) and present spirometry is >= 70%—Jan 1, 2024Active
M1214Spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and reviewed—Jan 1, 2024Active
M1215Documentation of medical reason(s) for not documenting and reviewing spirometry results (e.g., patients with dementia or tracheostomy)—Jan 1, 2024Active
M1216No spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and/or no spirometry performed with results documented during the encounter—Jan 1, 2024Active
M1217Documentation of system reason(s) for not documenting and reviewing spirometry results (e.g., spirometry equipment not available at the time of the encounter)—Jan 1, 2024Active
M1218Patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing)—Jan 1, 2024Active
M1219Anaphylaxis due to the vaccine on or before the date of the encounter—Jan 1, 2024Ended Dec 31, 2024
M1220Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; with evidence of retinopathy—Jan 1, 2024Active
M1221Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy—Jan 1, 2024Active
M1222Glaucoma plan of care not documented, reason not otherwise specifiedNOC / NOS—Jan 1, 2024Active
M1223Glaucoma plan of care documented—Jan 1, 2024Active
M1224Intraocular pressure (iop) reduced by a value less than 20% from the pre-intervention level—Jan 1, 2024Active
M1225Intraocular pressure (iop) reduced by a value of greater than or equal to 20% from the pre-intervention level—Jan 1, 2024Active
M1226Iop measurement not documented, reason not otherwise specifiedNOC / NOS—Jan 1, 2024Active
M1227Evidence-based therapy was prescribed—Jan 1, 2024Active
M1228Patient, 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—Jan 1, 2024Active
M1229Patient, 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—Jan 1, 2024Active
M1230Patient 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—Jan 1, 2024Active
M1231Patient receives hcv antibody test with nonreactive result—Jan 1, 2024Active
M1232Patient receives hcv antibody test with reactive result—Jan 1, 2024Active
M1233Patient does not receive hcv antibody test or patient does receive hcv antibody test but results not documented, reason not given—Jan 1, 2024Active
M1234Patient has a reactive hcv antibody test, and has a follow up hcv viral test that does not detect hcv viremia—Jan 1, 2024Active
M1235Documentation or patient report of hcv antibody test or hcv rna test which occurred prior to the performance period—Jan 1, 2024Active
M1236Baseline mrs > 2—Jan 1, 2024Active
M1237Patient reason for not screening for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety (e.g., patient declined or other patient reasons)—Jan 1, 2024Active
M1238Documentation 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)—Jan 1, 2024Active
M1239Patient did not respond to the question of patient felt heard and understood by this provider and team—Jan 1, 2024Active
M1240Patient did not respond to the question of patient felt this provider and team put my best interests first when making recommendations about my care—Jan 1, 2024Active
M1241Patient 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—Jan 1, 2024Active
M1242Patient did not respond to the question of patient felt this provider and team understood what is important to me in my life—Jan 1, 2024Active
M1243Patient provided a response other than "completely true" for the question of patient felt heard and understood by this provider and team—Jan 1, 2024Active
M1244Patient 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—Jan 1, 2024Active
M1245Patient 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—Jan 1, 2024Active
M1246Patient 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—Jan 1, 2024Active
M1247Patient responded "completely true" for the question of patient felt this provider and team put my best interests first when making recommendations about my care—Jan 1, 2024Active
M1248Patient 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—Jan 1, 2024Active
M1249Patient responded "completely true" for the question of patient felt this provider and team understood what is important to me in my life—Jan 1, 2024Active
M1250Patient responded as "completely true" for the question of patient felt heard and understood by this provider and team—Jan 1, 2024Active
M1251Patients for whom a proxy completed the entire hu survey on their behalf for any reason (no patient involvement)—Jan 1, 2024Active
M1252Patients 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—Jan 1, 2024Active
M1253Patients 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)—Jan 1, 2024Active
M1254Patients who were deceased when the hu survey reached them—Jan 1, 2024Active
M1255Patients 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)—Jan 1, 2024Active
M1256Prior history of known cvd—Jan 1, 2024Active
M1257Cvd risk assessment not performed or incomplete (e.g., cvd risk assessment was not documented), reason not otherwise specifiedNOC / NOS—Jan 1, 2024Active
M1258Cvd risk assessment performed, have a documented calculated risk score—Jan 1, 2024Active
M1259Patient status documented within the first year of initiating dialysis—Jan 1, 2024Active
M1260Patient status not documented within the first year of initiating dialysis—Jan 1, 2024Active
M1261Patients that were on the kidney or kidney-pancreas waitlist prior to initiation of dialysis—Jan 1, 2024Active
M1262Patients who had a transplant prior to initiation of dialysis—Jan 1, 2024Active
M1263Patients in hospice on their initiation of dialysis date or during the month of evaluation—Jan 1, 2024Active
M1264Patients age 75 or older on their initiation of dialysis date—Jan 1, 2024Ended Dec 31, 2024
M1265Cms medical evidence form 2728 for dialysis patients: initial form completed—Jan 1, 2024Active
M1266Patients admitted to a skilled nursing facility (snf)—Jan 1, 2024Active
M1267Patients 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—Jan 1, 2024Active
M1268Patients observed in active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period—Jan 1, 2024Active
M1269Receiving esrd mcp dialysis services by the provider on the last day of the reporting month—Jan 1, 2024Active
M1270Patients not on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period—Jan 1, 2024Active
M1271Patients with dementia at any time prior to or during the month—Jan 1, 2024Active
M1272Patients observed on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period—Jan 1, 2024Active
M1273Patients who were admitted to a skilled nursing facility (snf) within one year of dialysis initiation according to the cms-2728 form—Jan 1, 2024Active
M1274Patients who were admitted to a skilled nursing facility (snf) during the month of evaluation were excluded from that month—Jan 1, 2024Active
M1275Patients determined to be in hospice were excluded from month of evaluation and the remainder of reporting period—Jan 1, 2024Active
M1276Bmi documented outside normal parameters, no follow-up plan documented, no reason given—Jan 1, 2024Active
M1277Colorectal cancer screening results documented and reviewed—Jan 1, 2024Active
M1278Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented—Jan 1, 2024Active
M1279Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given—Jan 1, 2024Active
M1280Women 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—Jan 1, 2024Active
M1281Blood pressure reading not documented, reason not given—Jan 1, 2024Active
M1282Patient screened for tobacco use and identified as a tobacco non-user—Jan 1, 2024Active
M1283Patient screened for tobacco use and identified as a tobacco user—Jan 1, 2024Active
M1284Patients 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—Jan 1, 2024Active
M1285Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specifiedNOC / NOS—Jan 1, 2024Active
M1286Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason—Jan 1, 2024Active
M1287Bmi is documented below normal parameters and a follow-up plan is documented—Jan 1, 2024Active
M1288Documented reason for not screening or recommending a follow-up for high blood pressure—Jan 1, 2024Active
M1289Patient 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)—Jan 1, 2024Active
M1290Patient not eligible due to active diagnosis of hypertension—Jan 1, 2024Active
M1291Patients 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—Jan 1, 2024Active
M1292Patients 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—Jan 1, 2024Active
M1293Bmi is documented above normal parameters and a follow-up plan is documented—Jan 1, 2024Active
M1294Normal blood pressure reading documented, follow-up not required—Jan 1, 2024Active
M1295Patients with a diagnosis or past history of total colectomy or colorectal cancer—Jan 1, 2024Active
M1296Bmi is documented within normal parameters and no follow-up plan is required—Jan 1, 2024Active