Showing codes M1413 (Patients who had a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy) — P2 (A patient with mild systemic disease)

M1413 - Pos pdl1 bef init ici tx
Long description: Patients who had a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy
Code added date: 20250101.
Code effective date: 20250101.
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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M1414 - Med rsn no pdl1 bef 1st ther
Long description: Documentation of medical reason(s) for not performing the pd-l1 biomarker expression test prior to initiation of first-line immune checkpoint inhibitor therapy (e.g., patient is in an urgent or emergent situation where delay of treatment would jeopardize the patient's health status; other medical reasons/contraindication)
Code added date: 20250101.
Code effective date: 20250101.
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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M1415 - No pos pdl1 bef ici ther
Long description: Patients who did not have a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy
Code added date: 20250101.
Code effective date: 20250101.
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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M1416 - Pt rec hosp
Long description: Patient received hospice services any time during the performance period
Code added date: 20250101.
Code effective date: 20250101.
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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M1417 - Pt up to date cov
Long description: Patients who are up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination
Code added date: 20250101.
Code effective date: 20250101.
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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M1418 - Med rsn not up to date cov
Long description: Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination because of a medical contraindication documented by clinician
Code added date: 20250101.
Code effective date: 20250101.
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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M1419 - Pt not up to date cov
Long description: Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination
Code added date: 20250101.
Code effective date: 20250101.
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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M1420 - Complete ophthalmologic mvp
Long description: Complete ophthalmologic care mips value pathway
Code added date: 20250101.
Code effective date: 20250101.
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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M1421 - Dermatological care mvp
Long description: Dermatological care mips value pathway
Code added date: 20250101.
Code effective date: 20250101.
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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M1422 - Gastroenterology care mvp
Long description: Gastroenterology care mips value pathway
Code added date: 20250101.
Code effective date: 20250101.
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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M1423 - Opt care urologic cnd mvp
Long description: Optimal care for patients with urologic conditions mips value pathway
Code added date: 20250101.
Code effective date: 20250101.
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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M1424 - Pulmonology care mvp
Long description: Pulmonology care mips value pathway
Code added date: 20250101.
Code effective date: 20250101.
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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M1425 - Surgical care mvp
Long description: Surgical care mips value pathway
Code added date: 20250101.
Code effective date: 20250101.
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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M2 - Medicare secondary payer
Long description: Medicare secondary payer (msp)
Code added date: 20070101.
Code effective date: 20070101.
Coverage Code: C (A code denoting Medicare coverage status).
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MA - Emer med cond susp/confirm
Long description: Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition
Code added date: 20200101.
Code effective date: 20250101.
Coverage Code: C (A code denoting Medicare coverage status).
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MB - Auc hardship, insuf internet
Long description: Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access
Code added date: 20200101.
Code effective date: 20250101.
Coverage Code: C (A code denoting Medicare coverage status).
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MC - Auc hardship, vendor issues
Long description: Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues
Code added date: 20200101.
Code effective date: 20250101.
Coverage Code: C (A code denoting Medicare coverage status).
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MD - Auc hardship, extreme circ
Long description: Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances
Code added date: 20200101.
Code effective date: 20250101.
Coverage Code: C (A code denoting Medicare coverage status).
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ME - Order adheres to auc
Long description: The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
Code added date: 20200101.
Code effective date: 20250101.
Coverage Code: C (A code denoting Medicare coverage status).
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MF - Order does not adhere to auc
Long description: The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
Code added date: 20200101.
Code effective date: 20250101.
Coverage Code: C (A code denoting Medicare coverage status).
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MG - Auc not applicable to order
Long description: The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional
Code added date: 20200101.
Code effective date: 20250101.
Coverage Code: C (A code denoting Medicare coverage status).
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MH - Auc consult not provided
Long description: Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider
Code added date: 20200101.
Code effective date: 20250101.
Coverage Code: C (A code denoting Medicare coverage status).
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MS - 6-mo maint/svc fee parts/lbr
Long description: Six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty
Code added date: 19890101.
Code effective date: 19970101.
Coverage Code: C (A code denoting Medicare coverage status).
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N1 - Group 1 oxygen cov crit met
Long description: Group 1 oxygen coverage criteria met
Code added date: 20230101.
Code effective date: 20230101.
Coverage Code: C (A code denoting Medicare coverage status).
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N2 - Group 2 oxygen cov crit met
Long description: Group 2 oxygen coverage criteria met
Code added date: 20230101.
Code effective date: 20230101.
Coverage Code: C (A code denoting Medicare coverage status).
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N3 - Group 3 oxygen cov crit met
Long description: Group 3 oxygen coverage criteria met
Code added date: 20230101.
Code effective date: 20230101.
Coverage Code: C (A code denoting Medicare coverage status).
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NB - Drug specific nebulizer
Long description: Nebulizer system, any type, fda-cleared for use with specific drug
Code added date: 20110101.
Code effective date: 20110101.
Coverage Code: C (A code denoting Medicare coverage status).
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NR - New when rented
Long description: New when rented (use the 'nr' modifier when dme which was new at the time of rental is subsequently purchased)
Code added date: 19840101.
Code effective date: 19970101.
Coverage Code: C (A code denoting Medicare coverage status).
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NU - New equipment
Long description: New equipment
Code added date: 19840101.
Code effective date: 19970101.
Coverage Code: C (A code denoting Medicare coverage status).
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P1 - Normal healthy patient
Long description: A normal healthy patient
Code added date: 20060101.
Code effective date: 20060101.
Coverage Code: C (A code denoting Medicare coverage status).
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P2 - Patient w/mild syst disease
Long description: A patient with mild systemic disease
Code added date: 20060101.
Code effective date: 20060101.
Coverage Code: C (A code denoting Medicare coverage status).
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