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• M1013

  Discharge/discontinuation of the episode of care documented in the medical record

• M1014

  Discharge/discontinuation of the episode of care documented in the medical record

• M1015

  Discharge/discontinuation of the episode of care documented in the medical record

• M1016

  Female patients unable to bear children

• M1017

  Patient admitted to palliative care services

• M1018

  Patients with an active diagnosis or history of cancer (except basal cell and squamous cell skin carcinoma), patients who are heavy tobacco smokers, lung cancer screening patients

• M1019

  Adolescent patients 12 to 17 years of age with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5

• M1020

  Adolescent patients 12 to 17 years of age with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq-9 or phq-9m score was not assessed or is greater than or equal to 5

• M1021

  Patient had only urgent care visits during the performance period

• M1022

  Patients who were in hospice at any time during the performance period

• M1023

  Adolescent patients 12 to 17 years of age with major depression or dysthymia who reached remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five

• M1024

  Adolescent patients 12 to 17 years of age with major depression or dysthymia who did not reach remission at six months as demonstrated by a six month (+/-60 days) phq-9 or phq-9m score of less than five. either phq-9 or phq-9m score was not assessed or is greater than or equal to five

• M1025

  Patients who were in hospice at any time during the performance period

• M1026

  Patients who were in hospice at any time during the performance period

• M1027

  Imaging of the head (ct or mri) was obtained

• M1028

  Documentation of patients with primary headache diagnosis and imaging other than ct or mri obtained

• M1029

  Imaging of the head (ct or mri) was not obtained, reason not given

• M1030

  Patients with clinical indications for imaging of the head

• M1031

  Patients with no clinical indications for imaging of the head

• M1032

  Adults currently taking pharmacotherapy for oud

• M1033

  Pharmacotherapy for oud initiated after june 30th of performance period

• M1034

  Adults who have at least 180 days of continuous pharmacotherapy with a medication prescribed for oud without a gap of more than seven days

• M1035

  Adults who are deliberately phased out of medication assisted treatment (mat) prior to 180 days of continuous treatment

• M1036

  Adults who have not had at least 180 days of continuous pharmacotherapy with a medication prescribed for oud without a gap of more than seven days

• M1037

  Patients with a diagnosis of lumbar spine region cancer at the time of the procedure

• M1038

  Patients with a diagnosis of lumbar spine region fracture at the time of the procedure

• M1039

  Patients with a diagnosis of lumbar spine region infection at the time of the procedure

• M1040

  Patients with a diagnosis of lumbar idiopathic or congenital scoliosis

• M1041

  Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis

• M1042

  Functional status measurement with score was obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively

• M1043

  Functional status was not measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively

• M1044

  Functional status was measured by the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively

• M1045

  Functional status measured by the oxford knee score (oks) at one year (9 to 15 months) postoperatively was greater than or equal to 37 or knee injury and osteoarthritis outcome score joint replacement (koos, jr.) was greater than or equal to 71

• M1046

  Functional status measured by the oxford knee score (oks) at one year (9 to 15 months) postoperatively was less than 37 or the knee injury and osteoarthritis outcome score joint replacement (koos, jr.) was less than 71 postoperatively

• M1047

  Functional status was measured by the oxford knee score (oks) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively

• M1048

  Functional status measurement with score was obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at three months (6 to 20 weeks) postoperatively

• M1049

  Functional status was not measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively

• M1050

  Functional status was measured by the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at three months (6 to 20 weeks) postoperatively

• M1051

  Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis

• M1052

  Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively

• M1053

  Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively

• M1054

  Patient had only urgent care visits during the performance period

• M1055

  Aspirin or another antiplatelet therapy used

• M1056

  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 non-steroidal anti-inflammatory agents, drug-drug interaction, uncontrolled hypertension > 180/110 mmhg or gastroesophageal reflux disease

• M1057

  Aspirin or another antiplatelet therapy not used, reason not given

• M1058

  Patient was a permanent nursing home resident at any time during the performance period

• M1059

  Patient was in hospice or receiving palliative care at any time during the performance period

• M1060

  Patient died prior to the end of the performance period

• M1061

  Patient pregnancy

• M1062

  Patient immunocompromised

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HCPCS Level II codes and descriptors are approved and maintained jointly by the alpha-numeric editorial panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association). — Updated 7/20/2026

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