| Code | Description |
|---|---|
| M0064 |
Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders
Terminated December 31, 2014. |
| M0075 | Cellular therapy |
| M0076 | Prolotherapy |
| M0100 | Intragastric hypothermia using gastric freezing |
| M0201 | Covid-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient's home |
| 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 |
| 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 |
| M0222 | Intravenous injection, bebtelovimab, includes injection and post administration monitoring |
| 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 |
| M0239 |
Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring
Terminated April 16, 2021. |
| M0240 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses |
| 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 |
| M0243 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
| 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 |
| M0245 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring |
| 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 |
| M0247 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring |
| 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 |
| 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 |
| 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 |
| M0300 | Iv chelation therapy (chemical endarterectomy) |
| M0301 | Fabric wrapping of abdominal aneurysm |
| M1000 |
Pain screened as moderate to severe
Terminated December 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
Terminated December 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
Terminated December 31, 2019. |
| M1003 | Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic disease modifying anti-rheumatic drug therapy |
| 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) |
| M1005 | Tb screening not performed or results not interpreted, reason not given |
| M1006 | Disease activity not assessed, reason not given |
| M1007 | >=50% of total number of a patient's outpatient ra encounters assessed |
| M1008 | <50% of total number of a patient's outpatient ra encounters assessed |
| M1009 | Discharge/discontinuation of the episode of care documented in the medical record |
| M1010 | Discharge/discontinuation of the episode of care documented in the medical record |
| M1011 | Discharge/discontinuation of the episode of care documented in the medical record |
| M1012 | Discharge/discontinuation of the episode of care documented in the medical record |
| M1013 | Discharge/discontinuation of the episode of care documented in the medical record |
| M1014 | Discharge/discontinuation of the episode of care documented in the medical record |
| M1015 |
Discharge/discontinuation of the episode of care documented in the medical record
Terminated December 31, 2020. |
| M1016 | Female patients unable to bear children |
| M1017 | Patient admitted to palliative care services |
| 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 |
| 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 |
| 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 |
| M1021 | Patient had only urgent care visits during the performance period |
| M1022 |
Patients who were in hospice at any time during the performance period
Terminated December 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
Terminated December 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
Terminated December 31, 2020. |
| M1025 |
Patients who were in hospice at any time during the performance period
Terminated December 31, 2021. |
| M1026 |
Patients who were in hospice at any time during the performance period
Terminated December 31, 2021. |
| M1027 | Imaging of the head (ct or mri) was obtained |
| M1028 | Documentation of patients with primary headache diagnosis and imaging other than ct or mri obtained |
| M1029 | Imaging of the head (ct or mri) was not obtained, reason not given |
| M1030 |
Patients with clinical indications for imaging of the head
Terminated December 31, 2019. |
| M1031 |
Patients with no clinical indications for imaging of the head
Terminated December 31, 2021. |
| M1032 | Adults currently taking pharmacotherapy for oud |
| M1033 |
Pharmacotherapy for oud initiated after june 30th of performance period
Terminated December 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 |
| M1035 | Adults who are deliberately phased out of medication assisted treatment (mat) prior to 180 days of continuous treatment |
| 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 |
| M1037 | Patients with a diagnosis of lumbar spine region cancer at the time of the procedure |
| M1038 | Patients with a diagnosis of lumbar spine region fracture at the time of the procedure |
| M1039 | Patients with a diagnosis of lumbar spine region infection at the time of the procedure |
| M1040 | Patients with a diagnosis of lumbar idiopathic or congenital scoliosis |
| M1041 | Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis |
| 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
Terminated December 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 |
| 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
Terminated December 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 |
| 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 |
| 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
Terminated December 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
Terminated December 31, 2019. |
| M1049 | Functional status was not measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively |
| 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
Terminated December 31, 2019. |
| M1051 | Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis |
| M1052 | Leg pain was not measured by the visual analog scale (vas) at one year (9 to 15 months) postoperatively |
| M1053 |
Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively
Terminated December 31, 2019. |
| M1054 | Patient had only urgent care visits during the performance period |
| M1055 | Aspirin or another antiplatelet therapy used |
| 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 |
| M1057 | Aspirin or another antiplatelet therapy not used, reason not given |
| M1058 | Patient was a permanent nursing home resident at any time during the performance period |
| M1059 | Patient was in hospice or receiving palliative care at any time during the performance period |
| M1060 | Patient died prior to the end of the performance period |
| M1061 |
Patient pregnancy
Terminated December 31, 2020. |
| M1062 |
Patient immunocompromised
Terminated December 31, 2020. |
| M1063 |
Patients receiving high doses of immunosuppressive therapy
Terminated December 31, 2020. |
| M1064 |
Shingrix vaccine documented as administered or previously received
Terminated December 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)
Terminated December 31, 2020. |
| M1066 |
Shingrix vaccine not documented as administered, reason not given
Terminated December 31, 2020. |
| M1067 | Hospice services for patient provided any time during the measurement period |
| M1068 | Adults who are not ambulatory |
| M1069 | Patient screened for future fall risk |
| M1070 | Patient not screened for future fall risk, reason not given |
| M1071 | Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminotomy |
| M1106 | The start of an episode of care documented in the medical record |
| 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 |
| 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 |
| 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 |
| M1110 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) |
| M1111 | The start of an episode of care documented in the medical record |
| 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 |
| 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 |
| 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 |
| M1115 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) |
| M1116 | The start of an episode of care documented in the medical record |
| 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 |
| 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 |
| 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 |
| M1120 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) |
| M1121 | The start of an episode of care documented in the medical record |
| 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 |
| 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 |
| 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 |
| M1125 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) |
| M1126 | The start of an episode of care documented in the medical record |
| 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 |
| 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 |
| 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 |
| M1130 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) |
| 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 |
| 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 |
| 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 |
| M1134 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) |
| M1135 | The start of an episode of care documented in the medical record |
| M1136 |
The start of an episode of care documented in the medical record
Terminated December 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
Terminated December 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)
Terminated December 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)
Terminated December 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
Terminated December 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 |
| M1142 | Emergent cases |
| M1143 | Initiated episode of rehabilitation therapy, medical, or chiropractic care for neck impairment |
| M1144 |
Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only
Terminated December 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)
Terminated February 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 |
| 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 |
| M1148 | Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) |
| 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 |