M1265 – Cms medical evidence form 2728 for dialysis patients: initial form completed
HCPCS Level II code · M codes: Medical Services and Quality Measures
HCPCS codeM1265
- Long description
- Cms medical evidence form 2728 for dialysis patients: initial form completed
- Short description
- Cms 2728 completed
- Pricing indicator
00Not separately priced by Part B (bundled, not covered or Part A only)- Medicare coverage
CCarrier judgment – coverage decided by the Medicare contractor- BETOS category
Z2Undefined codes- Added
- January 1, 2024
- Last change
- January 1, 2024 – No change
Frequently asked questions
What is HCPCS code M1265?
M1265 is a HCPCS Level II code for cms medical evidence form 2728 for dialysis patients: initial form completed.
Does Medicare cover M1265?
The HCPCS file lists coverage code C: Carrier judgment – coverage decided by the Medicare contractor. Coverage and payment also depend on local coverage determinations and the patient’s plan.
Nearby M codes
- M1257 – Cvd risk assessment not performed or incomplete (e.g., cvd risk assessment was not documented), reason not otherwise specified
- M1258 – Cvd risk assessment performed, have a documented calculated risk score
- M1259 – Patient status documented within the first year of initiating dialysis
- M1260 – Patient status not documented within the first year of initiating dialysis
- M1261 – Patients that were on the kidney or kidney-pancreas waitlist prior to initiation of dialysis
- M1262 – Patients who had a transplant prior to initiation of dialysis
- M1263 – Patients in hospice on their initiation of dialysis date or during the month of evaluation
- M1264 – Patients age 75 or older on their initiation of dialysis date
- M1266 – Patients admitted to a skilled nursing facility (snf)
- M1267 – Patients not observed in active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
- M1268 – Patients observed in active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
- M1269 – Receiving esrd mcp dialysis services by the provider on the last day of the reporting month
- M1270 – Patients not on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
- M1271 – Patients with dementia at any time prior to or during the month
- M1272 – Patients observed on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
- M1273 – Patients who were admitted to a skilled nursing facility (snf) within one year of dialysis initiation according to the cms-2728 form
Source: CMS HCPCS Level II quarterly file, October 2026. Reference only – check payer policy before billing.