HCPCS Code Section: HCPCS M Codes

>=50% of total number of a patient’s outpatient ra encounters assessed Short Description: >=50% total pt outpt ra enct Coverage Code: Carrier judgment Action Code: No maintenance for this …

Disease activity not assessed, reason not given Short Description: Dz not ases, no rsn Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, …

Tb screening not performed or results not interpreted, reason not given Short Description: Tb scr no perf Coverage Code: Carrier judgment Action Code: No maintenance for this code Date …

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 …

Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic disease modifying anti-rheumatic drug therapy for ra Short Description: Tb scr 12 mo pri …

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 Short Description: Pln to …

Patient admitted to palliative care services Short Description: Pt admt to palitve serv Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2019 …

Female patients unable to bear children Short Description: Pt dx meop or sur steri Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, …

Discharge/discontinuation of the episode of care documented in the medical record Short Description: Dc eoc doc med rec Coverage Code: Carrier judgment Action Code: Change in long description of …