M1338 — Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores during the performance period
M1338 is a HCPCS Level II code for patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores during the performance period. 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 M1338
- Long descriptor
- Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores during the performance period
- Short descriptor
- Pt f/u 30-180 dys no + imprv
- 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 M1338
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1338 is not quite right, the correct code is very often within a few positions of it.
- 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
- M1334Patients with a post-operative encounter of the eye with the acute pvd within 2 weeks before the initial encounter or 2 weeks after initial acute pvd encounter
- M1335Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up)
- M1336Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 2 weeks
- M1337Acute pvd
- M1339Patients who had follow-up assessment 30 to 180 days after the index assessment who demonstrated positive improvement or maintenance of functioning scores during the performance period
- M1340Index assessment completed using the 12-item whodas 2.0 or sds during the denominator identification period
- M1341Patients who did not have a follow-up assessment or did not have an assessment within 30 to 180 days after the index assessment during the performance period
- M1342Patients who died during the performance period
- M1343Patients who are at pam level 4 at baseline or patients who are flagged with extreme straight line response sets on the pam or with excessive missing responses
- M1344Patients who did not have a baseline pam score and/or a second score within 4 to 12 months of baseline pam score
- M1345Patients who had a baseline pam score and a second score within 4 to 12 month of baseline pam score
- M1346Patients who did not have a net increase in pam score of at least 6 points within a 4 to 12 month period
Questions about M1338
What is HCPCS code M1338?
M1338 is a HCPCS Level II code for patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores during the performance period. It sits in the Medical Services section.
Does Medicare cover M1338?
The CMS HCPCS file marks M1338 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 M1338 paid under the physician fee schedule?
M1338 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.