M1054 – Patient had only urgent care visits during the performance period

Long description

Patient had only urgent care visits during the performance period

Short description

Pt uc in pp

Pricing indicator

00 Not separately priced by Part B (bundled, not covered or Part A only)

Medicare coverage

C Carrier judgment – coverage decided by the Medicare contractor

BETOS category

Z2 Undefined codes

Added

January 1, 2019

Last change

January 1, 2019 – No change

Nearby M codes

• M1046 – Functional status measured by the oxford knee score (oks) at one year (9 to 15 months) postoperatively was less than 37 or the knee injury and osteoarthritis outcome score joint replacement (koos, jr.) was less than 71 postoperatively
• M1047 – Functional status was measured by the oxford knee score (oks) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively
• M1048 – Functional status measurement with score was obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at three months (6 to 20 weeks) postoperatively
• M1049 – Functional status was not measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperatively
• M1050 – Functional status was measured by the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at three months (6 to 20 weeks) postoperatively
• M1051 – Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis
• M1052 – Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively
• M1053 – Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperatively
• M1055 – Aspirin or another antiplatelet therapy used
• M1056 – Prescribed anticoagulant medication during the performance period, history of gi bleeding, history of intracranial bleeding, bleeding disorder and specific provider documented reasons: allergy to aspirin or anti-platelets, use of non-steroidal anti-inflammatory agents, drug-drug interaction, uncontrolled hypertension > 180/110 mmhg or gastroesophageal reflux disease
• M1057 – Aspirin or another antiplatelet therapy not used, reason not given
• M1058 – Patient was a permanent nursing home resident at any time during the performance period
• M1059 – Patient was in hospice or receiving palliative care at any time during the performance period
• M1060 – Patient died prior to the end of the performance period
• M1061 – Patient pregnancy
• M1062 – Patient immunocompromised