HCPCS 2021

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
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
M1025 Patients who were in hospice at any time during the performance period
M1026 Patients who were in hospice at any time during the performance period
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
M1031 Patients with no clinical indications for imaging of the head
M1032 Adults currently taking pharmacotherapy for oud
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
M1043 Functional status was not measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively
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
M1049 Functional status was not measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively
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
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
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
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
M1145 Most favored nation (mfn) model drug add-on amount, per dose, (do not bill with line items that have the jw modifier)
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