M1162 — Patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday
M1162 is a HCPCS Level II code for patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday. It belongs to the Medical Services section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusM
Measurement code. Used for reporting purposes only; never paid.
Global period: XXX
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The CMS record for M1162
- Long descriptor
- Patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday
- Short descriptor
- Pt enceph due to dtp bef 13
- Added
- January 1, 2023
- BETOS
- Z2
- Pricing indicator
- 00 — Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to M1162
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1162 is not quite right, the correct code is very often within a few positions of it.
- M1154Hospice services provided to patient any time during the measurement periodterminated
- M1155Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement periodterminated
- M1156Patient received active chemotherapy any time during the measurement periodterminated
- M1157Patient received bone marrow transplant any time during the measurement periodterminated
- M1158Patient had history of immunocompromising conditions prior to or during the measurement periodterminated
- M1159Hospice services provided to patient any time during the measurement period
- M1160Patient had anaphylaxis due to the meningococcal vaccine any time on or before the patient's 13th birthday
- M1161Patient had anaphylaxis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday
- M1163Patient had anaphylaxis due to the hpv vaccine any time on or before the patient's 13th birthday
- M1164Patients with dementia any time during the patient's history through the end of the measurement period
- M1165Patients who use hospice services any time during the measurement period
- M1166Pathology report for tissue specimens produced from wide local excisions or re-excisions
- M1167In hospice or using hospice services during the measurement period
- M1168Patient received an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period
- M1169Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine)
- M1170Patient did not receive an influenza vaccine on or between july 1 of the year prior to the measurement period and june 30 of the measurement period
Questions about M1162
What is HCPCS code M1162?
M1162 is a HCPCS Level II code for patient had encephalitis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday. It sits in the Medical Services section.
Does Medicare cover M1162?
The CMS HCPCS file marks M1162 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is M1162 paid under the physician fee schedule?
M1162 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.