M1304 No pneum vax admin 19+

Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period

Medicare pricing for M1304

Physician Fee Schedule (CY 2026, RVU26D)

Status M: measurement code, reporting only.

Payer policies and prior authorization for M1304

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.