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HCPCS Level II/M-Codes/M1280

M1280 HCPCS Level II Code: Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy

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

Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy is a HCPCS Level II code (M1280). CMS assigns coverage code C — Carrier judgment. Short description: Bilat mast/hx bi /unilat mas.

Change history

  • 2024-01-01
    Added to the code set
    Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy

Contextual Map

Every relationship of M1280 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Nearest codes (40)

  • M1259 — Patient status documented within the first year of initiating dialysis [Sibling]
  • M1260 — Patient status not documented within the first year of initiating dialysis [Sibling]
  • M1261 — Patients that were on the kidney or kidney-pancreas waitlist prior to initiation of dialysis [Sibling]
  • M1262 — Patients who had a transplant prior to initiation of dialysis [Sibling]
  • M1263 — Patients in hospice on their initiation of dialysis date or during the month of evaluation [Sibling]
  • M1264 — Patients age 75 or older on their initiation of dialysis date [Sibling]
  • M1265 — Cms medical evidence form 2728 for dialysis patients: initial form completed [Sibling]
  • M1266 — Patients admitted to a skilled nursing facility (snf) [Sibling]
  • and 32 more

Change history

  • 2024-01-01 — Added to the code set [Change history]

Nearest Codes in This Family

Official HCPCS Level II classifications closest to M1280 in its code family, with their registry titles.

  • M1275 — Patients determined to be in hospice were excluded from month of evaluation and the remainder of reporting period
  • M1276 — Bmi documented outside normal parameters, no follow-up plan documented, no reason given
  • M1277 — Colorectal cancer screening results documented and reviewed
  • M1278 — Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented
  • M1279 — Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given
  • M1281 — Blood pressure reading not documented, reason not given
  • M1282 — Patient screened for tobacco use and identified as a tobacco non-user
  • M1283 — Patient screened for tobacco use and identified as a tobacco user
  • M1284 — Patients age 66 or older in institutional special needs plans (snp) or residing in long term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period
  • M1285 — Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified