HCPCS Service Codes - Medical care

HCPCS Codes for Medical care

• M1169

  Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine)

• 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

• 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

• 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)

• 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

• 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

• M1175

  Documentation of medical reason(s) for not administering zoster vaccine (e.g., prior anaphylaxis due to the zoster vaccine)

• 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

• M1177

  Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period

• M1178

  Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., prior anaphylaxis due to the pneumococcal vaccine)

• M1179

  Patient did not receive any pneumococcal conjugate or polysaccharide vaccine, on or after their 19th birthday and before or during measurement period

• M1180

  Patients on immune checkpoint inhibitor therapy

• M1181

  Grade 2 or above diarrhea and/or grade 2 or above colitis

• M1182

  Patients not eligible due to pre-existing inflammatory bowel disease (ibd) (e.g., ulcerative colitis, crohn's disease)

• M1183

  Documentation of immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered

• 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)

• M1185

  Documentation of immune checkpoint inhibitor therapy not held and/or corticosteroids or immunosuppressants prescribed or administered was not performed, reason not given

• M1186

  Patients who have an order for or are receiving hospice or palliative care

• M1187

  Patients with a diagnosis of end stage renal disease (esrd)

• M1188

  Patients with a diagnosis of chronic kidney disease (ckd) stage 5

• M1189

  Documentation of a kidney health evaluation defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) performed

• 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)

• M1191

  Hospice services provided to patient any time during the measurement period

• M1192

  Patients with an existing diagnosis of squamous cell carcinoma of the esophagus

• 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

• 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)

• 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

• M1196

  Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4

• M1197

  Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score

• M1198

  Itch 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

• M1199

  Patients receiving rrt

• M1200

  Ace inhibitor (ace-i) or arb therapy prescribed during the measurement period

• M1201

  Documentation 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)

• M1202

  Documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons)

• M1203

  Ace inhibitor or arb therapy not prescribed during the measurement period, reason not given

• M1204

  Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4

• M1205

  Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score

• M1206

  Itch 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

• M1207

  Patient is screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety

• M1208

  Patient is not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety

• M1209

  At least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses

• M1210

  At least two orders for high-risk medications from the same drug class, (table 4), not ordered

• M1211

  Most recent glycemic status assessment (hba1c or gmi) level > 9.0%

• M1212

  Glycemic status assessment (hba1c or gmi) level is missing, or was not performed during the measurement period

• M1213

  No history of spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) and present spirometry is >= 70%

• M1214

  Spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and reviewed

• M1215

  Documentation of medical reason(s) for not documenting and reviewing spirometry results (e.g., patients with dementia or tracheostomy)

• M1216

  No spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and/or no spirometry performed with results documented during the encounter

• M1217

  Documentation of system reason(s) for not documenting and reviewing spirometry results (e.g., spirometry equipment not available at the time of the encounter)

• M1218

  Patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing)