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

  • M1146

    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

  • M1147

    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

  • M1148

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

  • M1149

    Patient unable to complete the neck fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility, and an adequate proxy is not available

  • M1150

    Current or prior left ventricular ejection fraction (lvef) less than or equal to 40% or documentation of moderately or severely depressed left ventricular systolic function

  • M1151

    Patients with a history of heart transplant or with a left ventricular assist device (lvad)

  • M1152

    Patients with a history of heart transplant or with a left ventricular assist device (lvad)

  • M1153

    Patient with diagnosis of osteoporosis on date of encounter

  • M1154

    Hospice services provided to patient any time during the measurement period

  • M1155

    Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period

  • M1156

    Patient received active chemotherapy any time during the measurement period

  • M1157

    Patient received bone marrow transplant any time during the measurement period

  • M1158

    Patient had history of immunocompromising conditions prior to or during the measurement period

  • M1159

    Hospice services provided to patient any time during the measurement period

  • M1160

    Patient had anaphylaxis due to the meningococcal vaccine any time on or before the patient's 13th birthday

  • M1161

    Patient had anaphylaxis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday

  • M1162

    Patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday

  • M1163

    Patient had anaphylaxis due to the hpv vaccine any time on or before the patient's 13th birthday

  • M1164

    Patients with dementia any time during the patient's history through the end of the measurement period

  • M1165

    Patients who use hospice services any time during the measurement period

  • M1166

    Pathology report for tissue specimens produced from wide local excisions or re-excisions

  • M1167

    In hospice or using hospice services during the measurement period

  • M1168

    Patient received an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period

  • M1169

    Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine)

  • M1170

    Patient did not receive an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period

  • M1171

    Patient received at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period

  • M1172

    Documentation of medical reason(s) for not administering td or tdap vaccine (e.g., prior anaphylaxis due to the td or tdap vaccine or history of encephalopathy within seven days after a previous dose of a td-containing vaccine)

  • M1173

    Patient did not receive at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period

  • M1174

    Patient received at least two doses of the herpes zoster recombinant vaccine (at least 28 days apart) on october 20, 2017, through the end of the measurement period

  • M1175

    Documentation of medical reason(s) for not administering zoster vaccine (e.g., prior anaphylaxis due to the zoster vaccine)

  • M1176

    Patient did not receive two doses of the herpes zoster recombinant vaccine (at least 28 days apart) on october 20, 2017, through the end of the measurement period

  • M1177

    Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period

  • M1178

    Documentation of medical reason(s) for not administering pneumococcal vaccine (e.g., prior anaphylaxis due to the pneumococcal vaccine)

  • M1179

    Patient did not receive any pneumococcal conjugate or polysaccharide vaccine, on or after their 19th birthday and before or during measurement period

  • M1180

    Patients on immune checkpoint inhibitor therapy

  • M1181

    Grade 2 or above diarrhea and/or grade 2 or above colitis

  • M1182

    Patients not eligible due to pre-existing inflammatory bowel disease (ibd) (e.g., ulcerative colitis, crohn's disease)

  • M1183

    Documentation of immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered

  • M1184

    Documentation of medical reason(s) for not prescribing or administering corticosteroid or immunosuppressant treatment (e.g., allergy, intolerance, infectious etiology, pancreatic insufficiency, hyperthyroidism, prior bowel surgical interventions, celiac disease, receiving other medication, awaiting diagnostic workup results for alternative etiologies, other medical reasons/contraindication)

  • M1185

    Documentation of immune checkpoint inhibitor therapy not held and/or corticosteroids or immunosuppressants prescribed or administered was not performed, reason not given

  • M1186

    Patients who have an order for or are receiving hospice or palliative care

  • M1187

    Patients with a diagnosis of end stage renal disease (esrd)

  • M1188

    Patients with a diagnosis of chronic kidney disease (ckd) stage 5

  • M1189

    Documentation of a kidney health evaluation defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) performed

  • M1190

    Documentation of a kidney health evaluation was not performed or defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr)

  • M1191

    Hospice services provided to patient any time during the measurement period

  • M1192

    Patients with an existing diagnosis of squamous cell carcinoma of the esophagus

  • M1193

    Surgical pathology reports that contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both

  • M1194

    Documentation of medical reason(s) surgical pathology reports did not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both tests were not included (e.g., patient will not be treated with checkpoint inhibitor therapy, no residual carcinoma is present in the sample [tissue exhausted or status post neoadjuvant treatment], insufficient tumor for testing)

  • M1195

    Surgical pathology reports that do not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both, reason not given