Showing codes M1035 (Adults who are deliberately phased out of medication assisted treatment (mat) prior to 180 days of continuous treatment) — 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))

M1035 - Adt pd out mat pr 180 dys tx
Long description: Adults who are deliberately phased out of medication assisted treatment (mat) prior to 180 days of continuous treatment
Code added date: 20190101.
Code effective date: 20190101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1036 - Adt no 180 dys pharmthry oud
Long description: 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
Code added date: 20190101.
Code effective date: 20190101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1037 - Pt dx lum sp reg cacr
Long description: Patients with a diagnosis of lumbar spine region cancer at the time of the procedure
Code added date: 20190101.
Code effective date: 20190101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1038 - Pt dx lum sp reg fract
Long description: Patients with a diagnosis of lumbar spine region fracture at the time of the procedure
Code added date: 20190101.
Code effective date: 20190101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1039 - Pt dx lum sp reg inf
Long description: Patients with a diagnosis of lumbar spine region infection at the time of the procedure
Code added date: 20190101.
Code effective date: 20190101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1040 - Pt dx lum idi or cong scol
Long description: Patients with a diagnosis of lumbar idiopathic or congenital scoliosis
Code added date: 20190101.
Code effective date: 20190101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1041 - Pt cr ft inf lm or pt id sl
Long description: Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis
Code added date: 20190101.
Code effective date: 20210101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1042 - Ftl st mea sco ot odi 3 mo
Long description: 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
Code added date: 20190101.
Code effective date: 20200101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1043 - Fs no odi 9-15mo
Long description: Functional status was not measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively
Code added date: 20190101.
Code effective date: 20200101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1044 - Ftl st mea odi 3 mo
Long description: 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
Code added date: 20190101.
Code effective date: 20200101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1045 - Fs oks 9-15mo >= 37 >= 71
Long description: 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
Code added date: 20190101.
Code effective date: 20210101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1046 - Fs oks 9-15mo < 37 < 71
Long description: 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
Code added date: 20190101.
Code effective date: 20210101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1047 - Fs msrd oks pre and post
Long description: 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
Code added date: 20190101.
Code effective date: 20200101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1048 - Fsm wth scr odi pre and post
Long description: 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
Code added date: 20190101.
Code effective date: 20200101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1049 - Fs wth scr no odi pre and p
Long description: Functional status was not measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively
Code added date: 20190101.
Code effective date: 20200101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1050 - Fs msrd odi pre and post
Long description: 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
Code added date: 20190101.
Code effective date: 20200101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1051 - Pt w/cancer scoliosis
Long description: Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis
Code added date: 20190101.
Code effective date: 20210101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1052 - Lg pn not meas w/ vas 1yr po
Long description: Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively
Code added date: 20190101.
Code effective date: 20230101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1053 - Pre and post vas wthn 3 mos
Long description: Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively
Code added date: 20190101.
Code effective date: 20200101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1054 - Pt uc in pp
Long description: Patient had only urgent care visits during the performance period
Code added date: 20190101.
Code effective date: 20190101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1055 - Aspirin used
Long description: Aspirin or another antiplatelet therapy used
Code added date: 20190101.
Code effective date: 20190101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1056 - Presc antico med in pp
Long description: 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
Code added date: 20190101.
Code effective date: 20190101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1057 - Aspirin not used, no rsn
Long description: Aspirin or another antiplatelet therapy not used, reason not given
Code added date: 20190101.
Code effective date: 20190101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1058 - Pt prm nurs hm res in pp
Long description: Patient was a permanent nursing home resident at any time during the performance period
Code added date: 20190101.
Code effective date: 20190101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1059 - Pt no prm nurs hm res in pp
Long description: Patient was in hospice or receiving palliative care at any time during the performance period
Code added date: 20190101.
Code effective date: 20190101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1060 - Pt died in pp
Long description: Patient died prior to the end of the performance period
Code added date: 20190101.
Code effective date: 20190101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1061 - Pt preg
Long description: Patient pregnancy
Code added date: 20190101.
Code effective date: 20210101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1062 - Pt imcomprmd
Long description: Patient immunocompromised
Code added date: 20190101.
Code effective date: 20210101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1063 - Pt rec hg dos imsup thpy
Long description: Patients receiving high doses of immunosuppressive therapy
Code added date: 20190101.
Code effective date: 20210101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1064 - Shing vac doc adm or pv rec
Long description: Shingrix vaccine documented as administered or previously received
Code added date: 20190101.
Code effective date: 20210101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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M1065 - Shing vac no adm clinc rsn
Long description: 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)
Code added date: 20190101.
Code effective date: 20210101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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