M1364 — Calculated 10-year ascvd risk score of >= 20 percent during the performance period
M1364 is a HCPCS Level II code for calculated 10-year ascvd risk score of >= 20 percent 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
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
The CMS record for M1364
- Long descriptor
- Calculated 10-year ascvd risk score of >= 20 percent during the performance period
- Short descriptor
- Ascvd risk >=20pct
- 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 M1364
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1364 is not quite right, the correct code is very often within a few positions of it.
- M1356Patients who died during the measurement period
- M1357Patients who had a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment
- M1358Patients who did not have a reduction in suicidal ideation and/or behavior upon follow-up assessment within 120 days of index assessment
- M1359Index assessment during the denominator period when the suicidal ideation and/or behavior symptoms or increased suicide risk by clinician determination occurs and a non-zero c-ssrs score is obtained
- M1360Suicidal ideation and/or behavior symptoms based on the c-ssrs
- M1361Suicide risk based on their clinician's evaluation or a clinician-rated tool
- M1362Patients who died during the measurement period
- M1363Patients who did not have a follow-up assessment within 120 days of the index assessment
- M1365Patient encounter during the performance period with hospice and palliative care specialty code 17
- M1366Focusing on women's health mips value pathway
- M1367Quality care for the treatment of ear, nose, and throat disorders mips value pathway
- M1368Prevention and treatment of infectious disorders including hepatitis c and hiv mips value pathway
- M1369Quality care in mental health and substance use disorders mips value pathway
- M1370Rehabilitative support for musculoskeletal care mips value pathway
- M1371Most recent glycemic status assessment (hba1c or gmi) level < 7.0%
- M1372Most recent glycemic status assessment (hba1c or gmi) level >= 7.0% and < 8.0%
Questions about M1364
What is HCPCS code M1364?
M1364 is a HCPCS Level II code for calculated 10-year ascvd risk score of >= 20 percent during the performance period. It sits in the Medical Services section.
Does Medicare cover M1364?
The CMS HCPCS file marks M1364 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 M1364 paid under the physician fee schedule?
M1364 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.