M1374 — An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period
M1374 is a HCPCS Level II code for an additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis 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 M1374
- Long descriptor
- An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period
- Short descriptor
- Ra dx enc 90 days dur per pd
- Added
- January 1, 2025
- 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 M1374
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1374 is not quite right, the correct code is very often within a few positions of it.
- 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%
- M1373Most recent glycemic status assessment (hba1c or gmi) level >= 8.0% and <= 9.0%
- M1375An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period
- M1376An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period
- M1377Recommended follow-up interval for repeat colonoscopy of 10 years documented in colonoscopy report and communicated with patient
- M1378Documentation of medical reason(s) for not recommending a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is >= 66 years old, or life expectancy < 10 years, other medical reasons)
- M1379A 10 year follow-up interval for colonoscopy not recommended, reason not otherwise specified
- M1380Filled at least two prescriptions during the performance period for any combination of the qualifying oral antipsychotic medications listed under "denominator note" or the long-acting injectable antipsychotic medications listed under "denominator note"
- M1381Patients with secondary stroke (e.g., a subsequent stroke that may occur with vasospasm in the setting of subarachnoid hemorrhage) within 5 days of the initial procedure
- M1382Patient encounter during the performance period with place of service code 11
Questions about M1374
What is HCPCS code M1374?
M1374 is a HCPCS Level II code for an additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period. It sits in the Medical Services section.
Does Medicare cover M1374?
The CMS HCPCS file marks M1374 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 M1374 paid under the physician fee schedule?
M1374 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.