HCPCS Code Section: HCPCS M Codes

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, …

Shingrix vaccine documented as administered or previously received Short Description: Shing vac doc adm or pv rec Coverage Code: Carrier judgment Action Code: No maintenance for this code Date …

Patients receiving high doses of immunosuppressive therapy Short Description: Pt rec hg dos imsup thpy Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January …

Patient immunocompromised Short Description: Pt imcomprmd Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2019 Effective Date: January 1, 2019 Termination Date:

Patient pregnancy Short Description: Pt preg Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2019 Effective Date: January 1, 2019 Termination Date:

Patient died prior to the end of the performance period Short Description: Pt died in pp Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: …

Patient was in hospice or receiving palliative care at any time during the performance period Short Description: Pt no prm nurs hm res in pp Coverage Code: Carrier judgment …

Patient was a permanent nursing home resident at any time during the performance period Short Description: Pt prm nurs hm res in pp Coverage Code: Carrier judgment Action Code: …

Aspirin or another antiplatelet therapy not used, reason not given Short Description: Aspirin not used, no rsn Coverage Code: Carrier judgment Action Code: No maintenance for this code Date …

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 …