HCPCS M codes

• 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 Quality care for patients with neurological conditions mips value pathway
• 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
• 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
• M0224 Intravenous infusion, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known sars-cov-2 exposure, who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, includes infusion and post administration monitoring
• M0231 Intravenous infusion, tocilizumabbavi, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation only, includes infusion and post administration monitoring, first dose
• M0232 Intravenous infusion, tocilizumabbavi, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation only, includes infusion and post administration monitoring, second dose
• M0233 Intravenous infusion, tocilizumab-aazg, for hospitalized adult patients 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
• M0234 Intravenous infusion, tocilizumab-aazg, for hospitalized adult patients 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
• M0235 Intravenous infusion, monoclonal antibody products with an indication for post-exposure prophylaxis or treatment of covid-19, for hospitalized adults and/or pediatric patients 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, not otherwise classified, first dose
• M0236 Intravenous infusion, monoclonal antibody products with an indication for post-exposure prophylaxis or treatment of covid-19, for hospitalized adults and/or pediatric patients 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, not otherwise classified, second dose
• M0237 Intravenous infusion, tocilizumab-anoh, for hospitalized adult patients 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
• M0238 Intravenous infusion, tocilizumab-anoh, for hospitalized adult patients 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
• M0239 Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring
• 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
• M1001 Plan of care to address moderate to severe pain documented on or before the date of the second visit with a clinician
• 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
• 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
• 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
• 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
• 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
• 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
• M1030 Patients with clinical indications for imaging of the head
• M1031 Patients with no clinical indications for imaging of the head
• M1032 Adults currently taking pharmacotherapy for oud
• M1033 Pharmacotherapy for oud initiated after june 30th of performance period
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• M1062 Patient immunocompromised
• M1063 Patients receiving high doses of immunosuppressive therapy
• M1064 Shingrix vaccine documented as administered or previously received
• 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)
• M1066 Shingrix vaccine not documented as administered, reason not given
• 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
• M1136 The start of an episode of care documented in the medical record
• 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
• M1138 Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only)
• 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)
• 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
• 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
• 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
• M1150 Current or prior 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
• M1157 Patient received bone marrow transplant any time during the measurement period
• M1158 Patient had history of immunocompromising conditions prior to or during the measurement period
• 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) on october 20, 2017, through the end of 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 two doses of the herpes zoster recombinant vaccine (at least 28 days apart) on october 20, 2017, through the end of the measurement period
• M1177 Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th 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 19th 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 glycemic status assessment (hba1c or gmi) level > 9.0%
• M1212 Glycemic status assessment (hba1c or gmi) level is missing, or was not performed during the measurement period
• M1213 No history of spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) and present spirometry is >= 70%
• M1214 Spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and reviewed
• M1215 Documentation of medical reason(s) for not documenting and reviewing spirometry results (e.g., patients with dementia or tracheostomy)
• M1216 No spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and/or no spirometry performed with results documented during the encounter
• M1217 Documentation of system reason(s) for not documenting and reviewing spirometry results (e.g., spirometry equipment not available at the time of the encounter)
• M1218 Patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing)
• M1219 Anaphylaxis due to the vaccine on or before the date of the encounter
• M1220 Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; with evidence of retinopathy
• M1221 Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy
• M1222 Glaucoma plan of care not documented, reason not otherwise specified
• M1223 Glaucoma plan of care documented
• M1224 Intraocular pressure (iop) reduced by a value less than 20% from the pre-intervention level
• M1225 Intraocular pressure (iop) reduced by a value of greater than or equal to 20% from the pre-intervention level
• M1226 Iop measurement not documented, reason not otherwise specified
• M1227 Evidence-based therapy was prescribed
• M1228 Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, has hcv treatment initiated within 3 months of the reactive hcv antibody test
• M1229 Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, is referred within 1 month of the reactive hcv antibody test to a clinician who treats hcv infection
• M1230 Patient has a reactive hcv antibody test and does not have a follow up hcv viral test, or patient has a reactive hcv antibody test and has a follow up hcv viral test that detects hcv viremia and is not referred to a clinician who treats hcv infection within 1 month and does not have hcv treatment initiated within 3 months of the reactive hcv antibody test, reason not given
• M1231 Patient receives hcv antibody test with nonreactive result
• M1232 Patient receives hcv antibody test with reactive result
• M1233 Patient does not receive hcv antibody test or patient does receive hcv antibody test but results not documented, reason not given
• M1234 Patient has a reactive hcv antibody test, and has a follow up hcv viral test that does not detect hcv viremia
• M1235 Documentation or patient report of hcv antibody test or hcv rna test which occurred prior to the performance period
• M1236 Baseline mrs > 2
• M1237 Patient reason for not screening for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety (e.g., patient declined or other patient reasons)
• M1238 Documentation that administration of second recombinant zoster vaccine could not occur during the performance period due to the recommended 2-6 month interval between doses (i.e, first dose received after october 31)
• M1239 Patient did not respond to the question of patient felt heard and understood by this provider and team
• M1240 Patient did not respond to the question of patient felt this provider and team put my best interests first when making recommendations about my care
• M1241 Patient did not respond to the question of patient felt this provider and team saw me as a person, not just someone with a medical problem
• M1242 Patient did not respond to the question of patient felt this provider and team understood what is important to me in my life
• M1243 Patient provided a response other than "completely true" for the question of patient felt heard and understood by this provider and team
• M1244 Patient provided a response other than "completely true" for the question of patient felt this provider and team put my best interests first when making recommendations about my care
• M1245 Patient provided a response other than "completely true" for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem
• 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 Patient status documented within the first year of initiating dialysis
• M1260 Patient status not documented within the first year of initiating 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 observed 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 observed in 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 observed 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 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 or with excessive missing responses
• M1344 Patients who did not have a baseline pam score and/or a second score within 4 to 12 months of baseline pam score
• M1345 Patients who had a baseline pam score and a second score within 4 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 4 to 12 month period
• M1347 Patients who achieved a net increase in pam score of at least 3 points in a 4 to 12 month period (passing)
• M1348 Patients who achieved a net increase in pam score of at least 6-points in a 4 to 12 month period (excellent)
• M1349 Patients who did not have a net increase in pam score of at least 3 points within a 4 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
• M1371 Most recent glycemic status assessment (hba1c or gmi) level < 7.0%
• M1372 Most recent glycemic status assessment (hba1c or gmi) level >= 7.0% and < 8.0%
• M1373 Most recent glycemic status assessment (hba1c or gmi) level >= 8.0% and <= 9.0%
• M1374 An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period
• M1375 An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period
• M1376 An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period
• M1377 Recommended follow-up interval for repeat colonoscopy of 10 years documented in colonoscopy report and communicated with patient
• M1378 Documentation of medical reason(s) for not recommending a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is >= 66 years old, or life expectancy < 10 years, other medical reasons)
• M1379 A 10 year follow-up interval for colonoscopy not recommended, reason not otherwise specified
• M1380 Filled at least two prescriptions during the performance period for any combination of the qualifying oral antipsychotic medications listed under "denominator note" or the long-acting injectable antipsychotic medications listed under "denominator note"
• M1381 Patients with secondary stroke (e.g., a subsequent stroke that may occur with vasospasm in the setting of subarachnoid hemorrhage) within 5 days of the initial procedure
• M1382 Patient encounter during the performance period with place of service code 11
• M1383 Acute pvd
• M1384 Patients who died during the performance period
• M1385 Documentation of patient reasons for patients who were not seen for the second pam survey (e.g., less than four months between baseline pam assessment and follow-up
• M1386 Patients with an excisional surgery for melanoma or melanoma in situ in the past 5 years with an initial ajcc staging of 0, i, or ii at the start of the performance period
• M1387 Patients who died during the performance period
• M1388 Patients with documentation of an exam performed for recurrence of melanoma
• M1390 Patients who do not have a documented exam performed for recurrence of melanoma or no documentation within the performance period
• M1391 All patients who were diagnosed with recurrent melanoma during the current performance period
• M1392 Documentation of patient reasons for no examination, i.e., refusal of examination or lost to follow-up (documentation must include information that the clinician was unable to reach the patient by phone, mail or secure electronic mail - at least one method must be documented)
• M1393 Patients who were not diagnosed with recurrent melanoma during the current performance period
• M1394 Stages i-iii breast cancer
• M1395 Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group
• M1396 Patients on a therapeutic clinical trial
• M1397 Patients with recurrence/disease progression
• M1398 Patients with baseline and follow-up promis surveys documented in the medical record
• M1399 Patients who leave the practice during the follow-up period
• M1400 Patients who died during the follow-up period
• M1401 Stages i-iii breast cancer
• M1402 Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group
• M1403 Patients with baseline and follow-up promis surveys documented in the medical record
• M1404 Patients on a therapeutic clinical trial
• M1405 Patients with recurrence/disease progression
• M1406 Patients who leave the practice during the follow-up period
• M1407 Patients who died during the follow-up period
• M1408 Patients who have germline brca testing completed before diagnosis of epithelial ovarian, fallopian tube, or primary peritoneal cancer
• M1409 Patients who received germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis
• M1410 Patients who did not have germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis
• M1411 Currently on first-line immune checkpoint inhibitors without chemotherapy
• M1412 Patients with metastatic nsclc with epidermal growth factor receptor (egfr) mutations, alk genomic tumor aberrations, or other targetable genomic abnormalities with approved first-line targeted therapy, such as nsclc with ros1 rearrangement, braf v600e mutation, ntrk 1/2/3 gene fusion, met ex14 skipping mutation, and ret rearrangement
• M1413 Patients who had a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy
• M1414 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)
• M1415 Patients who did not have a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy
• M1416 Patient received hospice services any time during the performance period
• M1417 Patients who are up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination
• M1418 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
• M1419 Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination
• M1420 Complete ophthalmologic care mips value pathway
• M1421 Dermatological care mips value pathway
• M1422 Gastroenterology care mips value pathway
• M1423 Optimal care for patients with urologic conditions mips value pathway
• M1424 Pulmonology care mips value pathway
• M1425 Surgical care mips value pathway
• M1426 Encounters conducted via telehealth
• M1427 Documentation of medical reason(s) for performing a bone scan (including documented pain related to prostate cancer, salvage therapy, other medical reasons)
• M1428 Patients who have bilateral absence of eyes any time during the patient's history through the end of the measurement period
• M1429 Retinal exam finding with evidence of retinopathy in left, right or both eyes with severity level documented
• M1430 Retinal exam finding without evidence of retinopathy in both eyes with severity level documented (in measurement year or in the prior year)
• M1431 Encounters conducted via telehealth
• M1432 Encounters conducted via telehealth
• M1433 Patient on oral chemotherapy on or within 30 days before denominator eligible encounter
• M1434 Patient on oral chemotherapy on or within 30 days after denominator eligible encounter
• M1435 Patient on oral chemotherapy during the performance period
• M1436 Encounters conducted via telehealth
• M1437 Encounters conducted via telehealth
• M1438 Time last known well to hospital arrival less than or equal to 3.5 hours (<= 210 minutes)
• M1439 Significant ocular conditions that impact the visual outcome of surgery
• M1440 Encounters conducted via telehealth
• M1441 Encounter corresponds to initial diagnosis of sleep apnea or first contact with sleep apnea diagnosed patient
• M1442 Encounters conducted via telehealth
• M1443 Encounters conducted via telehealth
• M1444 Delivery at < 39 weeks of gestation
• M1445 Postpartum care visit before or at 12 weeks of giving birth
• M1446 Patients who died any time prior to the end of the measure assessment period
• M1447 Patients with an active diagnosis of bipolar disorder any time prior to the end of the measure assessment period
• M1448 Patients with an active diagnosis of personality disorder any time prior to the end of the measure assessment period
• M1449 Patients with an active diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period
• M1450 Patients who received hospice or palliative care service any time during denominator identification period or the measure assessment period
• M1451 Patients with an active diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period
• M1452 Patient ever had a diagnosis of dementia
• M1453 Patients with a pre-operative visual acuity better than 20/40
• M1454 New cied
• M1455 Replaced or revised cied
• M1456 Patient had a heart transplant
• M1457 Patient had a diagnosis of asthma with any contact during the current or prior performance period or had asthma present on an active problem list any time during the performance period
• M1458 Patient died prior to the end of the performance period
• M1459 Patient was in hospice or receiving palliative care services at any time during the performance period
• M1460 Diagnosis for chronic obstructive pulmonary disease, emphysema, cystic fibrosis, or acute respiratory failure
• M1461 Patient diagnosis for chronic hepatitis c
• M1462 Patients with clinical indications for imaging of the head
• M1463 Documentation of at least two attempts to follow up with patient within 180 days of treatment
• M1464 No documentation of at least two attempts to follow up with patient within 180 days of treatment
• M1465 Patient follow up more than 180 days after treatment
• M1466 Patient had a lumbar fusion on the same date as the discectomy/laminectomy procedure
• M1467 Patients with an existing diagnosis of lynch syndrome
• M1468 Patient received recommended doses of hepatitis b vaccination based on age
• M1469 Patient has a history of hepatitis b illness or received a hepatitis b surface antigen, hepatitis b surface antibody, or total antibody to hepatitis b core antigen test with a positive result any time before or during the measurement period
• M1470 Documentation of medical reason(s) for not administering hepatitis b vaccine (e.g., prior anaphylaxis due to the hepatitis b vaccine)
• M1471 Documentation that patient is a medicare fee-for-service beneficiary and without additional supplementary insurance coverage for whom hep b vaccination is not reimbursable under current medicare part b coverage rules
• M1472 Patient did not receive recommended doses of hepatitis b vaccination based on age
• M1473 Patient situations, at any point during the denominator identification period, where the patient's functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools, such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders
• M1474 Patients with diagnosis of dementia
• M1475 Patients with diagnosis of huntington's disease
• M1476 Patients with diagnosis of cognitive impairment or alzheimer's disease
• M1477 Diagnosis of delirium
• M1478 Psychoactive substance abuse
• M1479 Patients whose functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders
• M1480 Patients whose functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders
• M1481 Patients receiving hospice or palliative care or who died during the measurement period
• M1482 Positive/detectable hepatitis c virus quantitative or qualitative rna test result during the denominator identification period
• M1483 Patients who achieve sustained virological response as identified by an hcv rna test (cpt 87522) or (cpt 87521) with a negative/undetectable hcv rna result that occurred 20 weeks to 12 months after the first positive/detectable hcv rna test result within the denominator identification period
• M1484 Patients who did not have a repeat hcv rna labs performed for medical reasons documented by clinician (e.g., patient with limited life expectancy, delay in treatment of hcv related to treatment of hiv, hbv, hepatocellular carcinoma, decompensated cirrhosis)
• M1485 Patients who did not achieve sustained virological response as identified by an hcv rna test (cpt 87522) or (cpt 87521) with a negative/undetectable hcv rna result that occurred 20 weeks to 12 months after the first positive/detectable hcv rna test result within the denominator identification period
• M1486 Patients admitted to a skilled nursing facility (snf) during the period of evaluation
• M1487 Patients in hospice in the year before or during the period of evaluation
• M1488 Patients with a diagnosis for dementia in the year before or during the period of evaluation
• M1489 Patient status documented
• M1490 Patient status not documented
• M1491 Receiving esrd mcp dialysis services by the provider during the performance period
• M1492 Patients who did not report a fall
• M1493 Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy)
• M1494 Patients that reported a fall since the last visit
• M1495 Patients that reported a fall occurred who had a plan of care for falls documented or patients that did not report a fall
• M1496 Patients that had a fall who did not have a plan of care for falls documented or do not have documentation of being assessed for falls
• M1497 Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy)
• M1498 Diagnostic radiology mips value pathway
• M1499 Interventional radiology mips value pathway
• M1500 Neuropsychology mips value pathway
• M1501 Pathology mips value pathway
• M1502 Podiatry mips value pathway
• M1503 Vascular surgery mips value pathway