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HCPCS Level II/M-Codes/M1172

M1172 HCPCS Level II Code: 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)

Medicare Coverage & Payment

  • Medicare coverage: Carrier judgment (CMS coverage code C)
  • Payment category: Service not separately priced (pricing indicator 00)
  • BETOS: Z2 — Undefined codes
  • Last CMS action 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 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) is a HCPCS Level II code (M1172). CMS assigns coverage code C — Carrier judgment. Short description: Doc med rsn no td/tdap.

Nearest Codes in This Family

Official HCPCS Level II classifications closest to M1172 in its code family, with their registry titles.

  • 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
  • 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