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HCPCS Level II/M-Codes/M1202

M1202 HCPCS Level II Code: Documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons)

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 patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons) is a HCPCS Level II code (M1202). CMS assigns coverage code C — Carrier judgment. Short description: Pt rsn no ace-i/arb rx.

Nearest Codes in This Family

Official HCPCS Level II classifications closest to M1202 in its code family, with their registry titles.

  • M1200 — Ace inhibitor (ace-i) or arb therapy prescribed during the measurement period
  • M1201 — Documentation of medical reason(s) for not prescribing ace inhibitor (ace-i) or arb therapy during the measurement period (e.g., pregnancy, history of angioedema to ace-i, other allergy to ace-i and arb, hyperkalemia or history of hyperkalemia while on ace-i or arb therapy, acute kidney injury due to ace-i or arb therapy), other medical reasons)
  • M1203 — Ace inhibitor or arb therapy not prescribed during the measurement period, reason not given
  • M1204 — Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4
  • M1205 — Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score
  • M1206 — Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter
  • M1207 — Patient is screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
  • M1208 — Patient is not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
  • M1209 — At least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses
  • M1210 — At least two orders for high-risk medications from the same drug class, (table 4), not ordered