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HCPCS Level II/M-Codes/M1169

M1169 HCPCS Level II Code: Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine)

Medicare Coverage & Payment

  • Medicare coverage: Carrier judgment (CMS coverage code C)
  • Payment category: Service not separately priced (pricing indicator 00)
  • BETOS: Z2
  • Effective: January 1, 2023

Source: CMS HCPCS Level II release. Coverage codes indicate how Medicare treats the code, not whether a specific claim will be paid; payer policy and documentation still govern.

Official Registry Overview & Definition

Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine) is a HCPCS Level II code (M1169) for a Medicare-covered supply, service, or procedure. Short description: Doc med rsn no flu vax.

Nearest Codes in This Family

Official HCPCS Level II classifications closest to M1169 in its code family, with their registry titles.

  • 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
  • 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