M1202 — Documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons)
M1202 is a HCPCS Level II code for documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons). 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
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
The CMS record for M1202
- Long descriptor
- Documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons)
- Short descriptor
- Pt rsn no ace-i/arb rx
- 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 M1202
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1202 is not quite right, the correct code is very often within a few positions of it.
- M1194Documentation of medical reason(s) surgical pathology reports did not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both tests were not included (e.g., patient will not be treated with checkpoint inhibitor therapy, no residual carcinoma is present in the sample [tissue exhausted or status post neoadjuvant treatment], insufficient tumor for testing)
- M1195Surgical pathology reports that do not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both, reason not given
- M1196Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4
- M1197Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score
- M1198Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter
- M1199Patients receiving rrt
- M1200Ace inhibitor (ace-i) or arb therapy prescribed during the measurement period
- M1201Documentation of medical reason(s) for not prescribing ace inhibitor (ace-i) or arb therapy during the measurement period (e.g., pregnancy, history of angioedema to ace-i, other allergy to ace-i and arb, hyperkalemia or history of hyperkalemia while on ace-i or arb therapy, acute kidney injury due to ace-i or arb therapy), other medical reasons)
- M1203Ace inhibitor or arb therapy not prescribed during the measurement period, reason not given
- M1204Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4
- M1205Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score
- M1206Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter
- M1207Patient is screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
- M1208Patient is not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
- M1209At least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses
- M1210At least two orders for high-risk medications from the same drug class, (table 4), not ordered
Questions about M1202
What is HCPCS code M1202?
M1202 is a HCPCS Level II code for documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons). It sits in the Medical Services section.
Does Medicare cover M1202?
The CMS HCPCS file marks M1202 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 M1202 paid under the physician fee schedule?
M1202 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.