M1255 — Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere)
M1255 is a HCPCS Level II code for patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere). 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 M1255
- Long descriptor
- Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere)
- Short descriptor
- Pts w/ othr rsn vst,+prg tst
- 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 M1255
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1255 is not quite right, the correct code is very often within a few positions of it.
- M1247Patient responded "completely true" for the question of patient felt this provider and team put my best interests first when making recommendations about my care
- M1248Patient responded "completely true" for the question of patient felt this provider and team saw me as a person, not just someone with a medical problem
- M1249Patient responded "completely true" for the question of patient felt this provider and team understood what is important to me in my life
- M1250Patient responded as "completely true" for the question of patient felt heard and understood by this provider and team
- M1251Patients for whom a proxy completed the entire hu survey on their behalf for any reason (no patient involvement)
- M1252Patients who did not complete at least one of the four patient experience hu survey items and return the hu survey within 60 days of the ambulatory palliative care visit
- M1253Patients who respond on the patient experience hu survey that they did not receive care by the listed ambulatory palliative care provider in the last 60 days (disavowal)
- M1254Patients who were deceased when the hu survey reached them
- M1256Prior history of known cvd
- M1257Cvd risk assessment not performed or incomplete (e.g., cvd risk assessment was not documented), reason not otherwise specified
- M1258Cvd risk assessment performed, have a documented calculated risk score
- M1259Patient status documented within the first year of initiating dialysis
- M1260Patient status not documented within the first year of initiating dialysis
- M1261Patients that were on the kidney or kidney-pancreas waitlist prior to initiation of dialysis
- M1262Patients who had a transplant prior to initiation of dialysis
- M1263Patients in hospice on their initiation of dialysis date or during the month of evaluation
Questions about M1255
What is HCPCS code M1255?
M1255 is a HCPCS Level II code for patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere). It sits in the Medical Services section.
Does Medicare cover M1255?
The CMS HCPCS file marks M1255 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 M1255 paid under the physician fee schedule?
M1255 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.