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)
Billable / valid for submission HCPCS Release 2026Q3
Short description: Pts w/ othr rsn vst,+prg tst
Version history
| Release | Valid from | Valid to | Description | Billable |
|---|---|---|---|---|
| 2026Q3 | 2026-07-01 | current | 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) | yes |
Related codes in M12
- 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)
- M1220 Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; with evidence of retinopathy