M1169 — Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine)
M1169 is a HCPCS Level II code for documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine). 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 M1169
- Long descriptor
- Documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine)
- Short descriptor
- Doc med rsn no flu vax
- 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 M1169
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1169 is not quite right, the correct code is very often within a few positions of it.
- M1161Patient had anaphylaxis due to the tetanus, diphtheria or pertussis vaccine any time on or before the patient's 13th birthday
- M1162Patient had encephalitis 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
- 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
- M1171Patient received at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period
- M1172Documentation of medical reason(s) for not administering td or tdap vaccine (e.g., prior anaphylaxis due to the td or tdap vaccine or history of encephalopathy within seven days after a previous dose of a td-containing vaccine)
- M1173Patient did not receive at least one td vaccine or one tdap vaccine between nine years prior to the encounter and the end of the measurement period
- M1174Patient received at least two doses of the herpes zoster recombinant vaccine (at least 28 days apart) on october 20, 2017, through the end of the measurement period
- M1175Documentation of medical reason(s) for not administering zoster vaccine (e.g., prior anaphylaxis due to the zoster vaccine)
- M1176Patient did not receive two doses of the herpes zoster recombinant vaccine (at least 28 days apart) on october 20, 2017, through the end of the measurement period
- M1177Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
Questions about M1169
What is HCPCS code M1169?
M1169 is a HCPCS Level II code for documentation of medical reason(s) for not administering influenza vaccine (e.g., prior anaphylaxis due to the influenza vaccine). It sits in the Medical Services section.
Does Medicare cover M1169?
The CMS HCPCS file marks M1169 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 M1169 paid under the physician fee schedule?
M1169 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.