HCPCS Service Codes - Medical care

HCPCS Service Code 1 for Medical care.

HCPCS Type of Service (TOS) code is an indicator that the contractor places on Form CMS-1500. The indicator is mainly used for data purposes, however in some instances, it affects payment. All HCPCS codes have a corresponding TOS indicator.

Below are all available HCPCS TOS codes. Find an HCPCS code based on the type of service.

HCPCS Codes for Medical care

  • 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

  • M1063

    Patients receiving high doses of immunosuppressive therapy

  • M1064

    Shingrix vaccine documented as administered or previously received

  • M1065

    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, vaccine not available or other system reasons)

  • M1066

    Shingrix vaccine not documented as administered, reason not given

  • M1067

    Hospice services for patient provided any time during the measurement period

  • M1068

    Adults who are not ambulatory

  • M1069

    Patient screened for future fall risk

  • M1070

    Patient not screened for future fall risk, reason not given

  • M1071

    Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminotomy

  • M1106

    The start of an episode of care documented in the medical record

  • M1107

    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

  • M1108

    Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record

  • M1109

    Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery

  • M1110

    Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)

  • M1111

    The start of an episode of care documented in the medical record

  • M1112

    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

  • M1113

    Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record

  • M1114

    Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery

  • M1115

    Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)

  • M1116

    The start of an episode of care documented in the medical record

  • M1117

    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

  • M1118

    Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record