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HCPCS Level II/M-Codes/M1375

M1375 HCPCS Level II Code: An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period

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, 2025

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

An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period is a HCPCS Level II code (M1375) for a Medicare-covered supply, service, or procedure. Short description: Ra dx enc 90 days dur per pd.

Nearest Codes in This Family

Official HCPCS Level II classifications closest to M1375 in its code family, with their registry titles.

  • M1370 — Rehabilitative support for musculoskeletal care mips value pathway
  • M1371 — Most recent glycemic status assessment (hba1c or gmi) level < 7.0%
  • M1372 — Most recent glycemic status assessment (hba1c or gmi) level >= 7.0% and < 8.0%
  • M1373 — Most recent glycemic status assessment (hba1c or gmi) level >= 8.0% and <= 9.0%
  • M1374 — An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period
  • M1376 — An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period
  • M1377 — Recommended follow-up interval for repeat colonoscopy of 10 years documented in colonoscopy report and communicated with patient
  • M1378 — Documentation of medical reason(s) for not recommending a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is >= 66 years old, or life expectancy < 10 years, other medical reasons)
  • M1379 — A 10 year follow-up interval for colonoscopy not recommended, reason not otherwise specified
  • M1380 — Filled at least two prescriptions during the performance period for any combination of the qualifying oral antipsychotic medications listed under "denominator note" or the long-acting injectable antipsychotic medications listed under "denominator note"