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HCPCS Level II/M-Codes/M1255

M1255 HCPCS Level II Code: Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere)

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, 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

Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere) is a HCPCS Level II code (M1255) for a Medicare-covered supply, service, or procedure. Short description: Pts w/ othr rsn vst,+prg tst.

Nearest Codes in This Family

Official HCPCS Level II classifications closest to M1255 in its code family, with their registry titles.

  • M1250 — Patient responded as "completely true" for the question of patient felt heard and understood by this provider and team
  • M1251 — Patients for whom a proxy completed the entire hu survey on their behalf for any reason (no patient involvement)
  • M1252 — Patients who did not complete at least one of the four patient experience hu survey items and return the hu survey within 60 days of the ambulatory palliative care visit
  • M1253 — Patients who respond on the patient experience hu survey that they did not receive care by the listed ambulatory palliative care provider in the last 60 days (disavowal)
  • M1254 — Patients who were deceased when the hu survey reached them
  • M1256 — Prior history of known cvd
  • M1257 — Cvd risk assessment not performed or incomplete (e.g., cvd risk assessment was not documented), reason not otherwise specified
  • M1258 — Cvd risk assessment performed, have a documented calculated risk score
  • M1259 — Patient status documented within the first year of initiating dialysis
  • M1260 — Patient status not documented within the first year of initiating dialysis