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HCPCS Level II/M-Codes/M1380

M1380 HCPCS Level II Code: 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"

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, 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

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" is a HCPCS Level II code (M1380). CMS assigns coverage code C — Carrier judgment. Short description: 2 rx in perf pd any com meds.

Nearest Codes in This Family

Official HCPCS Level II classifications closest to M1380 in its code family, with their registry titles.

  • M1375 — 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
  • M1381 — Patients with secondary stroke (e.g., a subsequent stroke that may occur with vasospasm in the setting of subarachnoid hemorrhage) within 5 days of the initial procedure
  • M1382 — Patient encounter during the performance period with place of service code 11
  • M1383 — Acute pvd
  • M1384 — Patients who died during the performance period
  • M1385 — Documentation of patient reasons for patients who were not seen for the second pam survey (e.g., less than four months between baseline pam assessment and follow-up