M1325 — Patients who were not seen for reasons documented by clinician for patient or medical reasons (e.g., inadequate time for follow-up, patients who received a prior intravitreal or periocular steroid injection within the last six (6) months and had a subsequent iop evaluation with iop <25mm hg within seven (7) weeks of treatment)
M1325 is a HCPCS Level II code for patients who were not seen for reasons documented by clinician for patient or medical reasons (e.g., inadequate time for follow-up, patients who received a prior intravitreal or periocular steroid injection within the last six (6) months and had a subsequent iop evaluation with iop <25mm hg within seven (7) weeks of treatment). 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 M1325
- Long descriptor
- Patients who were not seen for reasons documented by clinician for patient or medical reasons (e.g., inadequate time for follow-up, patients who received a prior intravitreal or periocular steroid injection within the last six (6) months and had a subsequent iop evaluation with iop <25mm hg within seven (7) weeks of treatment)
- Short descriptor
- Doc med rsn not seen
- 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 M1325
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1325 is not quite right, the correct code is very often within a few positions of it.
- M1317Patients who are counseled on connection with a csp and explicitly opt out
- M1318Patients who did not have documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening or documentation that there was no contact with a csp
- M1319Patients who had documented contact with a csp for at least one of their screened positive hrsns within 60 days after screening
- M1320Patients who screened positive for at least 1 of the 5 hrsns
- M1321Patients who were not seen within 7 weeks following the date of injection for follow up or who did not have a documented iop or no plan of care documented if the iop was >25 mm hg
- M1322Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with documented iop =<25 mm hg for injected eye
- M1323Patients seen within 7 weeks following the date of injection and are screened for elevated intraocular pressure (iop) with tonometry with documented iop >25 mm hg and a plan of care was documented
- M1324Patients who had an intravitreal or periocular corticosteroid injection (e.g., triamcinolone, preservative-free triamcinolone, dexamethasone, dexamethasone intravitreal implant, or fluocinolone intravitreal implant)
- M1326Patients with a diagnosis of hypotony
- M1327Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 8 weeks
- M1328Patients with a diagnosis of acute vitreous hemorrhage
- M1329Patients with a post-operative encounter of the eye with the acute pvd within 2 weeks before the initial encounter or 8 weeks after initial acute pvd encounter
- M1330Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up)
- M1331Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 8 weeks from initial exam
- M1332Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 2 weeks
- M1333Acute vitreous hemorrhage
Questions about M1325
What is HCPCS code M1325?
M1325 is a HCPCS Level II code for patients who were not seen for reasons documented by clinician for patient or medical reasons (e.g., inadequate time for follow-up, patients who received a prior intravitreal or periocular steroid injection within the last six (6) months and had a subsequent iop evaluation with iop <25mm hg within seven (7) weeks of treatment). It sits in the Medical Services section.
Does Medicare cover M1325?
The CMS HCPCS file marks M1325 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 M1325 paid under the physician fee schedule?
M1325 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.