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HCPCS Level II/M-Codes/M1221

M1221 HCPCS Level II Code: Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy

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, 2024

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

Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy is a HCPCS Level II code (M1221). CMS assigns coverage code C — Carrier judgment. Short description: Dre w/o rtnopthy.

Nearest Codes in This Family

Official HCPCS Level II classifications closest to M1221 in its code family, with their registry titles.

  • M1216 — No spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and/or no spirometry performed with results documented during the encounter
  • M1217 — Documentation of system reason(s) for not documenting and reviewing spirometry results (e.g., spirometry equipment not available at the time of the encounter)
  • M1218 — Patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing)
  • M1219 — Anaphylaxis due to the vaccine on or before the date of the encounter
  • M1220 — Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; with evidence of retinopathy
  • M1222 — Glaucoma plan of care not documented, reason not otherwise specified
  • M1223 — Glaucoma plan of care documented
  • M1224 — Intraocular pressure (iop) reduced by a value less than 20% from the pre-intervention level
  • M1225 — Intraocular pressure (iop) reduced by a value of greater than or equal to 20% from the pre-intervention level
  • M1226 — Iop measurement not documented, reason not otherwise specified