M1414 – 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)

Long description

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)

Short description

Med rsn no pdl1 bef 1st ther

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, 2025

Last change

January 1, 2025 – No change

Nearby M codes

• M1406 – Patients who leave the practice during the follow-up period
• M1407 – Patients who died during the follow-up period
• M1408 – Patients who have germline brca testing completed before diagnosis of epithelial ovarian, fallopian tube, or primary peritoneal cancer
• 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
• M1420 – Complete ophthalmologic care mips value pathway
• M1421 – Dermatological care mips value pathway
• M1422 – Gastroenterology care mips value pathway