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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 4 of 6
CodeLong descriptorPayment limit (Q4 2026)AddedStatus
M1297Bmi not documented due to medical reason or patient refusal of height or weight measurement—Jan 1, 2024Active
M1298Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter—Jan 1, 2024Active
M1299Influenza immunization administered or previously received—Jan 1, 2024Active
M1300Influenza 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)—Jan 1, 2024Active
M1301Patient 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)—Jan 1, 2024Active
M1302Screening, diagnostic, film digital or digital breast tomosynthesis (3d) mammography results documented and reviewed—Jan 1, 2024Active
M1303Hospice services provided to patient any time during the measurement period—Jan 1, 2024Active
M1304Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period—Jan 1, 2024Active
M1305Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period—Jan 1, 2024Active
M1306Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period—Jan 1, 2024Active
M1307Documentation stating the patient has received or is currently receiving palliative or hospice care—Jan 1, 2024Active
M1308Influenza immunization was not administered, reason not given—Jan 1, 2024Active
M1309Palliative care services provided to patient any time during the measurement period—Jan 1, 2024Active
M1310Patient 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—Jan 1, 2024Active
M1311Anaphylaxis due to the vaccine on or before the date of the encounter—Jan 1, 2024Active
M1312Patient not screened for tobacco use—Jan 1, 2024Active
M1313Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period—Jan 1, 2024Active
M1314Bmi not documented and no reason is given—Jan 1, 2024Active
M1315Colorectal cancer screening results were not documented and reviewed; reason not otherwise specifiedNOC / NOS—Jan 1, 2024Active
M1316Current tobacco non-user—Jan 1, 2024Active
M1317Patients who are counseled on connection with a csp and explicitly opt out—Jan 1, 2024Active
M1318Patients 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—Jan 1, 2024Active
M1319Patients who had documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening—Jan 1, 2024Active
M1320Patients who screened positive for at least 1 of the 5 hrsns—Jan 1, 2024Active
M1321Patients 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—Jan 1, 2024Active
M1322Patients 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—Jan 1, 2024Active
M1323Patients 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—Jan 1, 2024Active
M1324Patients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, dexamethasone intravitreal implant, or fluocinolone intravitreal implant)—Jan 1, 2024Active
M1325Patients 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)—Jan 1, 2024Active
M1326Patients with a diagnosis of hypotony—Jan 1, 2024Active
M1327Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 8 weeks—Jan 1, 2024Active
M1328Patients with a diagnosis of acute vitreous hemorrhage—Jan 1, 2024Active
M1329Patients 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—Jan 1, 2024Active
M1330Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up)—Jan 1, 2024Active
M1331Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 8 weeks from initial exam—Jan 1, 2024Active
M1332Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 2 weeks—Jan 1, 2024Active
M1333Acute vitreous hemorrhage—Jan 1, 2024Active
M1334Patients 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—Jan 1, 2024Active
M1335Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up)—Jan 1, 2024Active
M1336Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 2 weeks—Jan 1, 2024Active
M1337Acute pvd—Jan 1, 2024Active
M1338Patients 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—Jan 1, 2024Active
M1339Patients 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—Jan 1, 2024Active
M1340Index assessment completed using the 12-item whodas 2.0 or sds during the denominator identification period—Jan 1, 2024Active
M1341Patients 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—Jan 1, 2024Active
M1342Patients who died during the performance period—Jan 1, 2024Active
M1343Patients 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—Jan 1, 2024Active
M1344Patients who did not have a baseline pam score and/or a second score within 4 to 12 months of baseline pam score—Jan 1, 2024Active
M1345Patients who had a baseline pam score and a second score within 4 to 12 month of baseline pam score—Jan 1, 2024Active
M1346Patients who did not have a net increase in pam score of at least 6 points within a 4 to 12 month period—Jan 1, 2024Active
M1347Patients who achieved a net increase in pam score of at least 3 points in a 4 to 12 month period (passing)—Jan 1, 2024Active
M1348Patients who achieved a net increase in pam score of at least 6-points in a 4 to 12 month period (excellent)—Jan 1, 2024Active
M1349Patients who did not have a net increase in pam score of at least 3 points within a 4 to 12 month period—Jan 1, 2024Active
M1350Patients 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—Jan 1, 2024Active
M1351Patients 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—Jan 1, 2024Active
M1352Suicidal ideation and/or behavior symptoms based on the c-ssrs or equivalent assessment—Jan 1, 2024Active
M1353Patients 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—Jan 1, 2024Active
M1354Patients 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—Jan 1, 2024Active
M1355Suicide risk based on their clinician's evaluation or a clinician-rated tool—Jan 1, 2024Active
M1356Patients who died during the measurement period—Jan 1, 2024Active
M1357Patients who had a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment—Jan 1, 2024Active
M1358Patients who did not have a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment—Jan 1, 2024Active
M1359Index 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—Jan 1, 2024Active
M1360Suicidal ideation and/or behavior symptoms based on the c-ssrs—Jan 1, 2024Active
M1361Suicide risk based on their clinician's evaluation or a clinician-rated tool—Jan 1, 2024Active
M1362Patients who died during the measurement period—Jan 1, 2024Active
M1363Patients who did not have a follow-up assessment within 120 days of the index assessment—Jan 1, 2024Active
M1364Calculated 10-year ascvd risk score of >= 20 percent during the performance period—Jan 1, 2024Active
M1365Patient encounter during the performance period with hospice and palliative care specialty code 17—Jan 1, 2024Active
M1366Focusing on women's health mips value pathway—Jan 1, 2024Active
M1367Quality care for the treatment of ear, nose, and throat disorders mips value pathway—Jan 1, 2024Active
M1368Prevention and treatment of infectious disorders including hepatitis c and hiv mips value pathway—Jan 1, 2024Active
M1369Quality care in mental health and substance use disorders mips value pathway—Jan 1, 2024Active
M1370Rehabilitative support for musculoskeletal care mips value pathway—Jan 1, 2024Active
M1371Most recent glycemic status assessment (hba1c or gmi) level < 7.0%—Jan 1, 2025Active
M1372Most recent glycemic status assessment (hba1c or gmi) level >= 7.0% and < 8.0%—Jan 1, 2025Active
M1373Most recent glycemic status assessment (hba1c or gmi) level >= 8.0% and <= 9.0%—Jan 1, 2025Active
M1374An 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—Jan 1, 2025Active
M1375An 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—Jan 1, 2025Active
M1376An 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—Jan 1, 2025Active
M1377Recommended follow-up interval for repeat colonoscopy of 10 years documented in colonoscopy report and communicated with patient—Jan 1, 2025Active
M1378Documentation 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)—Jan 1, 2025Active
M1379A 10 year follow-up interval for colonoscopy not recommended, reason not otherwise specified—Jan 1, 2025Active
M1380Filled 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"—Jan 1, 2025Active
M1381Patients 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—Jan 1, 2025Active
M1382Patient encounter during the performance period with place of service code 11—Jan 1, 2025Active
M1383Acute pvd—Jan 1, 2025Active
M1384Patients who died during the performance period—Jan 1, 2025Active
M1385Documentation 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—Jan 1, 2025Active
M1386Patients 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—Jan 1, 2025Active
M1387Patients who died during the performance period—Jan 1, 2025Active
M1388Patients with documentation of an exam performed for recurrence of melanoma—Jan 1, 2025Active
M1390Patients who do not have a documented exam performed for recurrence of melanoma or no documentation within the performance period—Jan 1, 2025Active
M1391All patients who were diagnosed with recurrent melanoma during the current performance period—Jan 1, 2025Active
M1392Documentation 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)—Jan 1, 2025Active
M1393Patients who were not diagnosed with recurrent melanoma during the current performance period—Jan 1, 2025Active
M1394Stages i-iii breast cancer—Jan 1, 2025Active
M1395Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group—Jan 1, 2025Active
M1396Patients on a therapeutic clinical trial—Jan 1, 2025Active
M1397Patients with recurrence/disease progression—Jan 1, 2025Active