HCPCS Code 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)
Code effective Jan 01, 2024

HCPCS Section
Medical services

M1255 is a valid 2026 HCPCS code meaning 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) or (Pts w/ othr rsn vst,+prg tst) for short. HCPCS M1255 has been effective since 01/01/2024 and applies to Medical care.

HCPCS Code Details - M1255

HCPCS Level II Code
Section M - Medical services
HCPCS Code M1255
Description

Long description:
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)

Short description:
Pts w/ othr rsn vst,+prg tst

HCPCS Pricing indicator 00 - Physician Fee Schedule And Non-Physician Practitioners - Service not separately priced by part B (e.g., services not covered, bundled, used by Part A only, etc.)
Multiple pricing indicator 9 - Not applicable as HCPCS not priced separately by part B or value is not established
Coverage code C - Carrier judgment
BETOS2 code Z2 - Undefined codes
HCPCS Action code N - No maintenance for this code
Type of service 1 - Medical care
Effective date Effective Jan 01, 2024
Date added Added Jan 01, 2024

See also

  • HCPCS M1254 · Patients who were deceased when the hu survey reached them

  • HCPCS G8860 · Patients who have received dose of corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days

  • HCPCS G9469 · Patients who have received or are receiving corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 90 or greater consecutive days or a single prescription equating to 900 mg prednisone or greater for all fills

  • HCPCS G9675 · Patients who have ever had a fasting or direct laboratory result of ldl-c = 190 mg/dl

  • HCPCS G9774 · Patients who have had a hysterectomy

  • HCPCS G9778 · Patients who have a diagnosis of pregnancy at any time during the measurement period

  • HCPCS G9780 · Patients who have a diagnosis of rhabdomyolysis at any time during the performance period

  • HCPCS M1186 · Patients who have an order for or are receiving hospice or palliative care

  • HCPCS M1408 · Patients who have germline brca testing completed before diagnosis of epithelial ovarian, fallopian tube, or primary peritoneal cancer

  • HCPCS M1428 · Patients who have bilateral absence of eyes any time during the patient's history through the end of the measurement period

  • HCPCS M1256 · Prior history of known cvd

1 Two-digit numeric codes are Level I code modifiers copyrighted© by the American Medical Association's Current Procedural Terminology (CPT).

2 BETOS stands for “Berenson-Eggers Type Of Service”

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 6/23/2026

CPT® is a registered trademark of the American Medical Association (AMA). All rights reserved.