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HCPCS Level II/M-Codes/M1414

M1414 HCPCS Level II Code: Documentation of medical reason(s) for not performing the pd-l1 biomarker expression test prior to initiation of first-line immune checkpoint inhibitor therapy (e.g., patient is in an urgent or emergent situation where delay of treatment would jeopardize the patient's health status; other medical reasons/contraindication)

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

Documentation of medical reason(s) for not performing the pd-l1 biomarker expression test prior to initiation of first-line immune checkpoint inhibitor therapy (e.g., patient is in an urgent or emergent situation where delay of treatment would jeopardize the patient's health status; other medical reasons/contraindication) is a HCPCS Level II code (M1414) for a Medicare-covered supply, service, or procedure. Short description: Med rsn no pdl1 bef 1st ther.

Nearest Codes in This Family

Official HCPCS Level II classifications closest to M1414 in its code family, with their registry titles.

  • M1409 — Patients who received germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis
  • M1410 — Patients who did not have germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis
  • M1411 — Currently on first-line immune checkpoint inhibitors without chemotherapy
  • M1412 — Patients with metastatic nsclc with epidermal growth factor receptor (egfr) mutations, alk genomic tumor aberrations, or other targetable genomic abnormalities with approved first-line targeted therapy, such as nsclc with ros1 rearrangement, braf v600e mutation, ntrk 1/2/3 gene fusion, met ex14 skipping mutation, and ret rearrangement
  • M1413 — Patients who had a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy
  • M1415 — Patients who did not have a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy
  • M1416 — Patient received hospice services any time during the performance period
  • M1417 — Patients who are up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination
  • M1418 — Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination because of a medical contraindication documented by clinician
  • M1419 — Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination