HCPCS Service Codes - Medical care

HCPCS Service Code 1 for Medical care.

HCPCS Type of Service (TOS) code is an indicator that the contractor places on Form CMS-1500. The indicator is mainly used for data purposes, however in some instances, it affects payment. All HCPCS codes have a corresponding TOS indicator.

Below are all available HCPCS TOS codes. Find an HCPCS code based on the type of service.

HCPCS Codes for Medical care

  • 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)

  • M1219

    Anaphylaxis due to the vaccine on or before the date of the encounter

  • M1220

    Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; with evidence of retinopathy

  • M1221

    Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy

  • M1222

    Glaucoma plan of care not documented, reason not otherwise specified

  • M1223

    Glaucoma plan of care documented

  • M1224

    Intraocular pressure (iop) reduced by a value less than 20% from the pre-intervention level

  • M1225

    Intraocular pressure (iop) reduced by a value of greater than or equal to 20% from the pre-intervention level

  • M1226

    Iop measurement not documented, reason not otherwise specified

  • M1227

    Evidence-based therapy was prescribed

  • M1228

    Patient, 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

  • M1229

    Patient, 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

  • M1230

    Patient 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

  • M1231

    Patient receives hcv antibody test with nonreactive result

  • M1232

    Patient receives hcv antibody test with reactive result

  • M1233

    Patient does not receive hcv antibody test or patient does receive hcv antibody test but results not documented, reason not given

  • M1234

    Patient has a reactive hcv antibody test, and has a follow up hcv viral test that does not detect hcv viremia

  • M1235

    Documentation or patient report of hcv antibody test or hcv rna test which occurred prior to the performance period

  • M1236

    Baseline mrs > 2

  • M1237

    Patient reason for not screening for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety (e.g., patient declined or other patient reasons)

  • M1238

    Documentation 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)

  • M1239

    Patient did not respond to the question of patient felt heard and understood by this provider and team

  • M1240

    Patient did not respond to the question of patient felt this provider and team put my best interests first when making recommendations about my care

  • M1241

    Patient 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

  • M1242

    Patient did not respond to the question of patient felt this provider and team understood what is important to me in my life

  • M1243

    Patient provided a response other than "completely true" for the question of patient felt heard and understood by this provider and team

  • M1244

    Patient 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

  • M1245

    Patient 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