M1496 – Patients that had a fall who did not have a plan of care for falls documented or do not have documentation of being assessed for falls
HCPCS Level II code · M codes: Medical Services and Quality Measures
HCPCS codeM1496
- Long description
- Patients that had a fall who did not have a plan of care for falls documented or do not have documentation of being assessed for falls
- Short description
- No doc of fall or poc
- 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, 2026
- Last change
- January 1, 2026 – No change
Frequently asked questions
What is HCPCS code M1496?
M1496 is a HCPCS Level II code for patients that had a fall who did not have a plan of care for falls documented or do not have documentation of being assessed for falls.
Does Medicare cover M1496?
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
- M1488 – Patients with a diagnosis for dementia in the year before or during the period of evaluation
- M1489 – Patient status documented
- M1490 – Patient status not documented
- M1491 – Receiving esrd mcp dialysis services by the provider during the performance period
- M1492 – Patients who did not report a fall
- M1493 – Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy)
- M1494 – Patients that reported a fall since the last visit
- M1495 – Patients that reported a fall occurred who had a plan of care for falls documented or patients that did not report a fall
- M1497 – Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy)
- M1498 – Diagnostic radiology mips value pathway
- M1499 – Interventional radiology mips value pathway
- M1500 – Neuropsychology mips value pathway
- M1501 – Pathology mips value pathway
- M1502 – Podiatry mips value pathway
- M1503 – Vascular surgery mips value pathway
Source: CMS HCPCS Level II quarterly file, October 2026. Reference only – check payer policy before billing.