M1397 — Patients with recurrence/disease progression
M1397 is a HCPCS Level II code for patients with recurrence/disease progression. 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 M1397
- Long descriptor
- Patients with recurrence/disease progression
- Short descriptor
- Pt w/ recur/prog
- 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 M1397
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1397 is not quite right, the correct code is very often within a few positions of it.
- M1388Patients with documentation of an exam performed for recurrence of melanoma
- M1390Patients who do not have a documented exam performed for recurrence of melanoma or no documentation within the performance period
- M1391All patients who were diagnosed with recurrent melanoma during the current performance period
- M1392Documentation of patient reasons for no examination, i.e., refusal of examination or lost to follow-up (documentation must include information that the clinician was unable to reach the patient by phone, mail or secure electronic mail - at least one method must be documented)
- M1393Patients who were not diagnosed with recurrent melanoma during the current performance period
- M1394Stages i-iii breast cancer
- M1395Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group
- M1396Patients on a therapeutic clinical trial
- M1398Patients with baseline and follow-up promis surveys documented in the medical record
- M1399Patients who leave the practice during the follow-up period
- M1400Patients who died during the follow-up period
- M1401Stages i-iii breast cancer
- M1402Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or group
- M1403Patients with baseline and follow-up promis surveys documented in the medical record
- M1404Patients on a therapeutic clinical trial
- M1405Patients with recurrence/disease progression
Questions about M1397
What is HCPCS code M1397?
M1397 is a HCPCS Level II code for patients with recurrence/disease progression. It sits in the Medical Services section.
Does Medicare cover M1397?
The CMS HCPCS file marks M1397 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 M1397 paid under the physician fee schedule?
M1397 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.