M1228 — Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, has hcv treatment initiated within 3 months of the reactive hcv antibody test
M1228 is a HCPCS Level II code for patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, has hcv treatment initiated within 3 months of the reactive hcv antibody test. 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 M1228
- Long descriptor
- Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, has hcv treatment initiated within 3 months of the reactive hcv antibody test
- Short descriptor
- Pt + hcv aby +vir w/ rx 3 mo
- Added
- January 1, 2024
- 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 M1228
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1228 is not quite right, the correct code is very often within a few positions of it.
- M1220Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; with evidence of retinopathy
- M1221Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy
- M1222Glaucoma plan of care not documented, reason not otherwise specified
- M1223Glaucoma plan of care documented
- M1224Intraocular pressure (iop) reduced by a value less than 20% from the pre-intervention level
- M1225Intraocular pressure (iop) reduced by a value of greater than or equal to 20% from the pre-intervention level
- M1226Iop measurement not documented, reason not otherwise specified
- M1227Evidence-based therapy was prescribed
- M1229Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, is referred within 1 month of the reactive hcv antibody test to a clinician who treats hcv infection
- M1230Patient has a reactive hcv antibody test and does not have a follow up hcv viral test, or patient has a reactive hcv antibody test and has a follow up hcv viral test that detects hcv viremia and is not referred to a clinician who treats hcv infection within 1 month and does not have hcv treatment initiated within 3 months of the reactive hcv antibody test, reason not given
- M1231Patient receives hcv antibody test with nonreactive result
- M1232Patient receives hcv antibody test with reactive result
- M1233Patient does not receive hcv antibody test or patient does receive hcv antibody test but results not documented, reason not given
- M1234Patient has a reactive hcv antibody test, and has a follow up hcv viral test that does not detect hcv viremia
- M1235Documentation or patient report of hcv antibody test or hcv rna test which occurred prior to the performance period
- M1236Baseline mrs > 2
Questions about M1228
What is HCPCS code M1228?
M1228 is a HCPCS Level II code for patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, has hcv treatment initiated within 3 months of the reactive hcv antibody test. It sits in the Medical Services section.
Does Medicare cover M1228?
The CMS HCPCS file marks M1228 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 M1228 paid under the physician fee schedule?
M1228 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.