M1284 Patients age 66 or older in institutional special needs plans (snp) or residing in long term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period
Billable / valid for submission HCPCS Release 2026Q3
Short description: Pt 66+ snp or ltc pos > 90d
Version history
| Release | Valid from | Valid to | Description | Billable |
|---|---|---|---|---|
| 2026Q3 | 2026-07-01 | current | Patients age 66 or older in institutional special needs plans (snp) or residing in long term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period | 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