Medical Services
| Code | Description |
|---|---|
| M0001 | Advancing cancer care mips value pathways |
| M0002 | Optimal care for kidney health mips value pathways |
| M0003 | Optimal care for patients with episodic neurological conditions mips value pathways |
| M0004 | Supportive care for neurodegenerative conditions mips value pathways |
| M0005 | Value in primary care mips value pathway |
| M0010 | Enhancing oncology model (eom) monthly enhanced oncology services (meos) payment for eom enhanced services |
| M0064 | Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disorders Terminated December 31, 2014. |
| M0075 | Cellular therapy |
| M0076 | Prolotherapy |
| M0100 | Intragastric hypothermia using gastric freezing |
| M0201 | Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient’s home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient’s home |
| M0220 | Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring |
| M0221 | Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency |
| M0222 | Intravenous injection, bebtelovimab, includes injection and post administration monitoring |
| M0223 | Intravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency |
| M0239 | Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring Terminated April 16, 2021. |
| M0240 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses |
| M0241 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency, subsequent repeat doses |
| M0243 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
| M0244 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency |
| M0245 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring |
| M0246 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider based to the hospital during the covid 19 public health emergency |
| M0247 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring |
| M0248 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency |
| M0249 | Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, first dose |
| M0250 | Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, second dose |
| M0300 | Iv chelation therapy (chemical endarterectomy) |
| M0301 | Fabric wrapping of abdominal aneurysm |
| M1000 | Pain screened as moderate to severe Terminated December 31, 2019. |
| M1001 | Plan of care to address moderate to severe pain documented on or before the date of the second visit with a clinician Terminated December 31, 2019. |
| M1002 | Plan of care for moderate to severe pain not documented on or before the date of the second visit with a clinician, reason not given Terminated December 31, 2019. |
| M1003 | Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic and/or immune response modifier 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 |
| M1015 | Discharge/discontinuation of the episode of care documented in the medical record Terminated December 31, 2020. |
| M1016 | Female patients unable to bear children |
| M1017 | Patient admitted to palliative care services Terminated December 31, 2022. |
| 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 Terminated December 31, 2021. |
| M1023 | Adolescent patients 12 to 17 years of age with major depression or dysthymia who reached remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five Terminated December 31, 2020. |
| M1024 | Adolescent patients 12 to 17 years of age with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five. either phq-9 or phq-9m score was not assessed or is greater than or equal to five Terminated December 31, 2020. |
| M1025 | Patients who were in hospice at any time during the performance period Terminated December 31, 2021. |
| M1026 | Patients who were in hospice at any time during the performance period Terminated December 31, 2021. |
| 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 |
| M1030 | Patients with clinical indications for imaging of the head Terminated December 31, 2019. |
| M1031 | Patients with no clinical indications for imaging of the head Terminated December 31, 2021. |
| M1032 | Adults currently taking pharmacotherapy for oud |
| M1033 | Pharmacotherapy for oud initiated after june 30th of performance period Terminated December 31, 2020. |
| 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 |
| M1042 | 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 Terminated December 31, 2019. |
| M1043 | Functional status was not measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively |
| M1044 | 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 Terminated December 31, 2019. |
| 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 |
| M1047 | 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 Terminated December 31, 2019. |
| M1048 | 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 Terminated December 31, 2019. |
| M1049 | Functional status was not measured by the oswestry disability index (odi version 2.1a) at three months (6 – 20 weeks) postoperatively |
| M1050 | 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 Terminated December 31, 2019. |
| 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) or numeric pain scale at one year (9 to 15 months) postoperatively |
| M1053 | Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively Terminated December 31, 2019. |
| 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 |
| M1061 | Patient pregnancy Terminated December 31, 2020. |
| M1062 | Patient immunocompromised Terminated December 31, 2020. |
| M1063 | Patients receiving high doses of immunosuppressive therapy Terminated December 31, 2020. |
| M1064 | Shingrix vaccine documented as administered or previously received Terminated December 31, 2020. |
| 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) Terminated December 31, 2020. |
| M1066 | Shingrix vaccine not documented as administered, reason not given Terminated December 31, 2020. |
| 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 Terminated December 31, 2022. |
| 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 |
| M1136 | The start of an episode of care documented in the medical record Terminated December 31, 2020. |
| M1137 | 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 Terminated December 31, 2020. |
| M1138 | Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only) Terminated December 31, 2020. |
| M1139 | Ongoing care not indicated, patient self-discharged early and seen only 1-2 visits (e.g., financial or insurance reasons, transportation problems, or reason unknown) Terminated December 31, 2020. |
| M1140 | Ongoing care not indicated, patient discharged after only 1-2 visits due to specific medical events, documented in the medical record that make the treatment episode impossible such as the patient becomes hospitalized or scheduled for surgery for surgery or hospitalized Terminated December 31, 2020. |
| 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 |
| M1144 | Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only Terminated December 31, 2020. |
| M1145 | Most favored nation (mfn) model drug add-on amount, per dose, (do not bill with line items that have the jw modifier) Terminated February 27, 2022. |
| 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 |
| M1150 | Left ventricular ejection fraction (lvef) less than or equal to 40% or documentation of moderately or severely depressed left ventricular systolic function |
| M1151 | Patients with a history of heart transplant or with a left ventricular assist device (lvad) |
| M1152 | Patients with a history of heart transplant or with a left ventricular assist device (lvad) |
| M1153 | Patient with diagnosis of osteoporosis on date of encounter |
| M1154 | Hospice services provided to patient any time during the measurement period |
| M1155 | Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period |
| M1156 | Patient received active chemotherapy any time during the measurement period Terminated December 31, 2023. |
| M1157 | Patient received bone marrow transplant any time during the measurement period Terminated December 31, 2023. |
| M1158 | Patient had history of immunocompromising conditions prior to or during the measurement period Terminated December 31, 2023. |
| M1159 | Hospice services provided to patient any time during the measurement period |
| M1160 | Patient had anaphylaxis due to the meningococcal vaccine any time on or before the patient’s 13th birthday |
| M1161 | Patient had anaphylaxis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient’s 13th birthday |
| M1162 | Patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient’s 13th birthday |
| M1163 | Patient had anaphylaxis due to the hpv vaccine any time on or before the patient’s 13th birthday |
| M1164 | Patients with dementia any time during the patient’s history through the end of the measurement period |
| M1165 | Patients who use hospice services any time during the measurement period |
| M1166 | Pathology report for tissue specimens produced from wide local excisions or re-excisions |
| M1167 | In hospice or using hospice services during the measurement period |
| M1168 | Patient received an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period |
| 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) anytime on or after the patient’s 50th birthday before or during 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 at least two doses of the herpes zoster recombinant vaccine (at least 28 days apart) anytime on or after the patient’s 50th birthday before or during the measurement period |
| M1177 | Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 60th 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 60th 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 hemoglobin a1c level > 9.0% |
| M1212 | Hemoglobin a1c level is missing, or was not performed during the measurement period (12 months) |
| 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 |
| M1246 | Patient provided a response other than “completely true” for the question of patient felt this provider and team understood what is important to me in my life |
| M1247 | Patient responded “completely true” for the question of patient felt this provider and team put my best interests first when making recommendations about my care |
| M1248 | Patient responded “completely true” for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem |
| M1249 | Patient responded “completely true” for the question of patient felt this provider and team understood what is important to me in my life |
| M1250 | Patient responded as “completely true” for the question of patient felt heard and understood by this provider and team |
| M1251 | Patients for whom a proxy completed the entire hu survey on their behalf for any reason (no patient involvement) |
| M1252 | Patients who did not complete at least one of the four patient experience hu survey items and return the hu survey within 60 days of the ambulatory palliative care visit |
| M1253 | Patients who respond on the patient experience hu survey that they did not receive care by the listed ambulatory palliative care provider in the last 60 days (disavowal) |
| M1254 | Patients who were deceased when the hu survey reached them |
| M1255 | Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere) |
| M1256 | Prior history of known cvd |
| M1257 | Cvd risk assessment not performed or incomplete (e.g., cvd risk assessment was not documented), reason not otherwise specified |
| M1258 | Cvd risk assessment performed, have a documented calculated risk score |
| M1259 | Patients listed on the kidney-pancreas transplant waitlist or who received a living donor transplant within the first year following initiation of dialysis |
| M1260 | Patients who were not listed on the kidney-pancreas transplant waitlist or patients who did not receive a living donor transplant within the first year following initiation of dialysis |
| M1261 | Patients that were on the kidney or kidney-pancreas waitlist prior to initiation of dialysis |
| M1262 | Patients who had a transplant prior to initiation of dialysis |
| M1263 | Patients in hospice on their initiation of dialysis date or during the month of evaluation |
| M1264 | Patients age 75 or older on their initiation of dialysis date |
| M1265 | Cms medical evidence form 2728 for dialysis patients: initial form completed |
| M1266 | Patients admitted to a skilled nursing facility (snf) |
| M1267 | Patients not on any kidney or kidney-pancreas transplant waitlist or is not in active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period |
| M1268 | Patients on active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period |
| M1269 | Receiving esrd mcp dialysis services by the provider on the last day of the reporting month |
| M1270 | Patients not on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period |
| M1271 | Patients with dementia at any time prior to or during the month |
| M1272 | Patients on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period |
| M1273 | Patients who were admitted to a skilled nursing facility (snf) within one year of dialysis initiation according to the cms-2728 form |
| M1274 | Patients who were admitted to a skilled nursing facility (snf) during the month of evaluation were excluded from that month |
| M1275 | Patients determined to be in hospice were excluded from month of evaluation and the remainder of reporting period |
| M1276 | Bmi documented outside normal parameters, no follow-up plan documented, no reason given |
| M1277 | Colorectal cancer screening results documented and reviewed |
| M1278 | Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented |
| M1279 | Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given |
| M1280 | Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy |
| M1281 | Blood pressure reading not documented, reason not given |
| M1282 | Patient screened for tobacco use and identified as a tobacco non-user |
| M1283 | Patient screened for tobacco use and identified as a tobacco user |
| M1284 | Patients age 66 or older in institutional special needs plans (snp) or residing in long term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period |
| M1285 | Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified |
| M1286 | Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason |
| M1287 | Bmi is documented below normal parameters and a follow-up plan is documented |
| M1288 | Documented reason for not screening or recommending a follow-up for high blood pressure |
| M1289 | Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy) |
| M1290 | Patient not eligible due to active diagnosis of hypertension |
| M1291 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| M1292 | Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| M1293 | Bmi is documented above normal parameters and a follow-up plan is documented |
| M1294 | Normal blood pressure reading documented, follow-up not required |
| M1295 | Patients with a diagnosis or past history of total colectomy or colorectal cancer |
| M1296 | Bmi is documented within normal parameters and no follow-up plan is required |
| M1297 | Bmi not documented due to medical reason or patient refusal of height or weight measurement |
| M1298 | Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter |
| M1299 | Influenza immunization administered or previously received |
| M1300 | Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) |
| M1301 | Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy) |
| M1302 | Screening, diagnostic, film digital or digital breast tomosynthesis (3d) mammography results documented and reviewed |
| M1303 | Hospice services provided to patient any time during the measurement period |
| M1304 | Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period |
| M1305 | Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period |
| M1306 | Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period |
| M1307 | Documentation stating the patient has received or is currently receiving palliative or hospice care |
| M1308 | Influenza immunization was not administered, reason not given |
| M1309 | Palliative care services provided to patient any time during the measurement period |
| M1310 | Patient screened for tobacco use and received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling, pharmacotherapy, or both), if identified as a tobacco user |
| M1311 | Anaphylaxis due to the vaccine on or before the date of the encounter |
| M1312 | Patient not screened for tobacco use |
| M1313 | Tobacco screening not performed or tobacco cessation intervention not provided during the measurement period or in the six months prior to the measurement period |
| M1314 | Bmi not documented and no reason is given |
| M1315 | Colorectal cancer screening results were not documented and reviewed; reason not otherwise specified |
| M1316 | Current tobacco non-user |
| M1317 | Patients who are counseled on connection with a csp and explicitly opt out |
| M1318 | Patients who did not have documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening or documentation that there was no contact with a csp |
| M1319 | Patients who had documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening |
| M1320 | Patients who screened positive for at least 1 of the 5 hrsns |
| M1321 | Patients who were not seen within 7 weeks following the date of injection for follow up or who did not have a documented iop or no plan of care documented if the iop was >25 mm hg |
| M1322 | Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with documented iop =<25 mm hg for injected eye |
| M1323 | Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with documented iop >25 mm hg and a plan of care was documented |
| M1324 | Patients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, dexamethasone intravitreal implant, or fluocinolone intravitreal implant) |
| M1325 | Patients who were not seen for reasons documented by clinician for patient or medical reasons (e.g., inadequate time for follow-up, patients who received a prior intravitreal or periocular steroid injection within the last six (6) months and had a subsequent iop evaluation with iop <25mm hg within seven (7) weeks of treatment) |
| M1326 | Patients with a diagnosis of hypotony |
| M1327 | Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 8 weeks |
| M1328 | Patients with a diagnosis of acute vitreous hemorrhage |
| M1329 | Patients with a post-operative encounter of the eye with the acute pvd within 2 weeks before the initial encounter or 8 weeks after initial acute pvd encounter |
| M1330 | Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up) |
| M1331 | Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 8 weeks from initial exam |
| M1332 | Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 2 weeks |
| M1333 | Acute vitreous hemorrhage |
| M1334 | Patients with a post-operative encounter of the eye with the acute pvd within 2 weeks before the initial encounter or 2 weeks after initial acute pvd encounter |
| M1335 | Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up) |
| M1336 | Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 2 weeks |
| M1337 | Acute pvd |
| M1338 | Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores during the performance period |
| M1339 | Patients who had follow-up assessment 30 to 180 days after the index assessment who demonstrated positive improvement or maintenance of functioning scores during the performance period |
| M1340 | Index assessment completed using the 12-item whodas 2.0 or sds during the denominator identification period |
| M1341 | Patients who did not have a follow-up assessment or did not have an assessment within 30 to 180 days after the index assessment during the performance period |
| M1342 | Patients who died during the performance period |
| M1343 | Patients who are at pam level 4 at baseline or patients who are flagged with extreme straight line response sets on the pam |
| M1344 | Patients who did not have a baseline pam score and/or a second score within 6 to 12 month of baseline pam score |
| M1345 | Patients who had a baseline pam score and a second score within 6 to 12 month of baseline pam score |
| M1346 | Patients who did not have a net increase in pam score of at least 6 points within a 6 to 12 month period |
| M1347 | Patients who achieved a net increase in pam score of at least 3 points in a 6 to 12 month period (passing) |
| M1348 | Patients who achieved a net increase in pam score of at least 6-points in a 6 to 12 month period (excellent) |
| M1349 | Patients who did not have a net increase in pam score of at least 3 points within 6 to 12 month period |
| M1350 | Patients who had a completed suicide safety plan initiated, reviewed or updated in collaboration with their clinician (concurrent or within 24 hours) of the index clinical encounter |
| M1351 | Patients who had a suicide safety plan initiated, reviewed, or updated and reviewed and updated in collaboration with the patient and their clinician concurrent or within 24 hours of clinical encounter and within 120 days after initiation |
| M1352 | Suicidal ideation and/or behavior symptoms based on the c-ssrs or equivalent assessment |
| M1353 | Patients who did not have a completed suicide safety plan initiated, reviewed or updated in collaboration with their clinician (concurrent or within 24 hours) of the index clinical encounter |
| M1354 | Patients who did not have a suicide safety plan initiated, reviewed, or updated or reviewed and updated in collaboration with the patient and their clinician concurrent or within 24 hours of clinical encounter and within 120 days after initiation |
| M1355 | Suicide risk based on their clinician’s evaluation or a clinician-rated tool |
| M1356 | Patients who died during the measurement period |
| M1357 | Patients who had a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment |
| M1358 | Patients who did not have a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment |
| M1359 | Index assessment during the denominator period when the suicidal ideation and/or behavior symptoms or increased suicide risk by clinician determination occurs and a non-zero c-ssrs score is obtained |
| M1360 | Suicidal ideation and/or behavior symptoms based on the c-ssrs |
| M1361 | Suicide risk based on their clinician’s evaluation or a clinician-rated tool |
| M1362 | Patients who died during the measurement period |
| M1363 | Patients who did not have a follow-up assessment within 120 days of the index assessment |
| M1364 | Calculated 10-year ascvd risk score of >= 20 percent during the performance period |
| M1365 | Patient encounter during the performance period with hospice and palliative care specialty code 17 |
| M1366 | Focusing on women’s health mips value pathway |
| M1367 | Quality care for the treatment of ear, nose, and throat disorders mips value pathway |
| M1368 | Prevention and treatment of infectious disorders including hepatitis c and hiv mips value pathway |
| M1369 | Quality care in mental health and substance use disorders mips value pathway |
| M1370 | Rehabilitative support for musculoskeletal care mips value pathway |