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 5 of 6
Code	Long descriptor	Payment limit (Q4 2026)	Added	Status
M1398	Patients with baseline and follow-up promis surveys documented in the medical record	—	Jan 1, 2025	Active
M1399	Patients who leave the practice during the follow-up period	—	Jan 1, 2025	Active
M1400	Patients who died during the follow-up period	—	Jan 1, 2025	Active
M1401	Stages i-iii breast cancer	—	Jan 1, 2025	Active
M1402	Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group	—	Jan 1, 2025	Active
M1403	Patients with baseline and follow-up promis surveys documented in the medical record	—	Jan 1, 2025	Active
M1404	Patients on a therapeutic clinical trial	—	Jan 1, 2025	Active
M1405	Patients with recurrence/disease progression	—	Jan 1, 2025	Active
M1406	Patients who leave the practice during the follow-up period	—	Jan 1, 2025	Active
M1407	Patients who died during the follow-up period	—	Jan 1, 2025	Active
M1408	Patients who have germline brca testing completed before diagnosis of epithelial ovarian, fallopian tube, or primary peritoneal cancer	—	Jan 1, 2025	Active
M1409	Patients who received germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis	—	Jan 1, 2025	Active
M1410	Patients who did not have germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis	—	Jan 1, 2025	Active
M1411	Currently on first-line immune checkpoint inhibitors without chemotherapy	—	Jan 1, 2025	Active
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	—	Jan 1, 2025	Active
M1413	Patients who had a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy	—	Jan 1, 2025	Active
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)	—	Jan 1, 2025	Active
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	—	Jan 1, 2025	Active
M1416	Patient received hospice services any time during the performance period	—	Jan 1, 2025	Active
M1417	Patients who are up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination	—	Jan 1, 2025	Active
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	—	Jan 1, 2025	Active
M1419	Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination	—	Jan 1, 2025	Active
M1420	Complete ophthalmologic care mips value pathway	—	Jan 1, 2025	Active
M1421	Dermatological care mips value pathway	—	Jan 1, 2025	Active
M1422	Gastroenterology care mips value pathway	—	Jan 1, 2025	Active
M1423	Optimal care for patients with urologic conditions mips value pathway	—	Jan 1, 2025	Active
M1424	Pulmonology care mips value pathway	—	Jan 1, 2025	Active
M1425	Surgical care mips value pathway	—	Jan 1, 2025	Active
M1426	Encounters conducted via telehealth	—	Jan 1, 2026	Active
M1427	Documentation of medical reason(s) for performing a bone scan (including documented pain related to prostate cancer, salvage therapy, other medical reasons)	—	Jan 1, 2026	Active
M1428	Patients who have bilateral absence of eyes any time during the patient's history through the end of the measurement period	—	Jan 1, 2026	Active
M1429	Retinal exam finding with evidence of retinopathy in left, right or both eyes with severity level documented	—	Jan 1, 2026	Active
M1430	Retinal exam finding without evidence of retinopathy in both eyes with severity level documented (in measurement year or in the prior year)	—	Jan 1, 2026	Active
M1431	Encounters conducted via telehealth	—	Jan 1, 2026	Active
M1432	Encounters conducted via telehealth	—	Jan 1, 2026	Active
M1433	Patient on oral chemotherapy on or within 30 days before denominator eligible encounter	—	Jan 1, 2026	Active
M1434	Patient on oral chemotherapy on or within 30 days after denominator eligible encounter	—	Jan 1, 2026	Active
M1435	Patient on oral chemotherapy during the performance period	—	Jan 1, 2026	Active
M1436	Encounters conducted via telehealth	—	Jan 1, 2026	Active
M1437	Encounters conducted via telehealth	—	Jan 1, 2026	Active
M1438	Time last known well to hospital arrival less than or equal to 3.5 hours (<= 210 minutes)	—	Jan 1, 2026	Active
M1439	Significant ocular conditions that impact the visual outcome of surgery	—	Jan 1, 2026	Active
M1440	Encounters conducted via telehealth	—	Jan 1, 2026	Active
M1441	Encounter corresponds to initial diagnosis of sleep apnea or first contact with sleep apnea diagnosed patient	—	Jan 1, 2026	Active
M1442	Encounters conducted via telehealth	—	Jan 1, 2026	Active
M1443	Encounters conducted via telehealth	—	Jan 1, 2026	Active
M1444	Delivery at < 39 weeks of gestation	—	Jan 1, 2026	Active
M1445	Postpartum care visit before or at 12 weeks of giving birth	—	Jan 1, 2026	Active
M1446	Patients who died any time prior to the end of the measure assessment period	—	Jan 1, 2026	Active
M1447	Patients with an active diagnosis of bipolar disorder any time prior to the end of the measure assessment period	—	Jan 1, 2026	Active
M1448	Patients with an active diagnosis of personality disorder any time prior to the end of the measure assessment period	—	Jan 1, 2026	Active
M1449	Patients with an active diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period	—	Jan 1, 2026	Active
M1450	Patients who received hospice or palliative care service any time during denominator identification period or the measure assessment period	—	Jan 1, 2026	Active
M1451	Patients with an active diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period	—	Jan 1, 2026	Active
M1452	Patient ever had a diagnosis of dementia	—	Jan 1, 2026	Active
M1453	Patients with a pre-operative visual acuity better than 20/40	—	Jan 1, 2026	Active
M1454	New cied	—	Jan 1, 2026	Active
M1455	Replaced or revised cied	—	Jan 1, 2026	Active
M1456	Patient had a heart transplant	—	Jan 1, 2026	Active
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	—	Jan 1, 2026	Active
M1458	Patient died prior to the end of the performance period	—	Jan 1, 2026	Active
M1459	Patient was in hospice or receiving palliative care services at any time during the performance period	—	Jan 1, 2026	Active
M1460	Diagnosis for chronic obstructive pulmonary disease, emphysema, cystic fibrosis, or acute respiratory failure	—	Jan 1, 2026	Active
M1461	Patient diagnosis for chronic hepatitis c	—	Jan 1, 2026	Active
M1462	Patients with clinical indications for imaging of the head	—	Jan 1, 2026	Active
M1463	Documentation of at least two attempts to follow up with patient within 180 days of treatment	—	Jan 1, 2026	Active
M1464	No documentation of at least two attempts to follow up with patient within 180 days of treatment	—	Jan 1, 2026	Active
M1465	Patient follow up more than 180 days after treatment	—	Jan 1, 2026	Active
M1466	Patient had a lumbar fusion on the same date as the discectomy/laminectomy procedure	—	Jan 1, 2026	Active
M1467	Patients with an existing diagnosis of lynch syndrome	—	Jan 1, 2026	Active
M1468	Patient received recommended doses of hepatitis b vaccination based on age	—	Jan 1, 2026	Active
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	—	Jan 1, 2026	Active
M1470	Documentation of medical reason(s) for not administering hepatitis b vaccine (e.g., prior anaphylaxis due to the hepatitis b vaccine)	—	Jan 1, 2026	Active
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	—	Jan 1, 2026	Active
M1472	Patient did not receive recommended doses of hepatitis b vaccination based on age	—	Jan 1, 2026	Active
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	—	Jan 1, 2026	Active
M1474	Patients with diagnosis of dementia	—	Jan 1, 2026	Active
M1475	Patients with diagnosis of huntington's disease	—	Jan 1, 2026	Active
M1476	Patients with diagnosis of cognitive impairment or alzheimer's disease	—	Jan 1, 2026	Active
M1477	Diagnosis of delirium	—	Jan 1, 2026	Active
M1478	Psychoactive substance abuse	—	Jan 1, 2026	Active
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	—	Jan 1, 2026	Active
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	—	Jan 1, 2026	Active
M1481	Patients receiving hospice or palliative care or who died during the measurement period	—	Jan 1, 2026	Active
M1482	Positive/detectable hepatitis c virus quantitative or qualitative rna test result during the denominator identification period	—	Jan 1, 2026	Active
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	—	Jan 1, 2026	Active
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)	—	Jan 1, 2026	Active
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	—	Jan 1, 2026	Active
M1486	Patients admitted to a skilled nursing facility (snf) during the period of evaluation	—	Jan 1, 2026	Active
M1487	Patients in hospice in the year before or during the period of evaluation	—	Jan 1, 2026	Active
M1488	Patients with a diagnosis for dementia in the year before or during the period of evaluation	—	Jan 1, 2026	Active
M1489	Patient status documented	—	Jan 1, 2026	Active
M1490	Patient status not documented	—	Jan 1, 2026	Active
M1491	Receiving esrd mcp dialysis services by the provider during the performance period	—	Jan 1, 2026	Active
M1492	Patients who did not report a fall	—	Jan 1, 2026	Active
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)	—	Jan 1, 2026	Active
M1494	Patients that reported a fall since the last visit	—	Jan 1, 2026	Active
M1495	Patients that reported a fall occurred who had a plan of care for falls documented or patients that did not report a fall	—	Jan 1, 2026	Active
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	—	Jan 1, 2026	Active
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)	—	Jan 1, 2026	Active