HCPCS Code Section: HCPCS M Codes

Adults who are not ambulatory Short Description: Pt not ambulatory Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2019 Effective Date: January …

Leg pain was not measured by the visual analog scale (vas) at one year (9 to 15 months) postoperatively Short Description: Lg pn not meas w/ vas 1yr po …

Hospice services for patient provided any time during the measurement period Short Description: Hspc pt prv time meam per Coverage Code: Carrier judgment Action Code: No maintenance for this …

Patient had cancer, fracture or infection related to the lumbar spine or patient had idiopathic or congenital scoliosis Short Description: Pt w/cancer scoliosis Coverage Code: Carrier judgment Action Code: …

Shingrix vaccine not documented as administered, reason not given Short Description: Shing vac no doc no rsn Coverage Code: Carrier judgment Action Code: No maintenance for this code Date …

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 …

Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only) Short Description: Oc ni pt 1-2 vis Coverage …

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 Short …

The start of an episode of care documented in the medical record Short Description: Start eoc doc med rec Coverage Code: Carrier judgment Action Code: Add procedure or modifier …