M1473 — Patient situations, at any point during the denominator identification period, where the patient's functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools, such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders
M1473 is a HCPCS Level II code for patient situations, at any point during the denominator identification period, where the patient's functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools, such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders. 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 M1473
- Long descriptor
- Patient situations, at any point during the denominator identification period, where the patient's functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools, such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders
- Short descriptor
- Pt func cap not allow impr
- Added
- January 1, 2026
- 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 M1473
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1473 is not quite right, the correct code is very often within a few positions of it.
- M1465Patient follow up more than 180 days after treatment
- M1466Patient had a lumbar fusion on the same date as the discectomy/laminectomy procedure
- M1467Patients with an existing diagnosis of lynch syndrome
- M1468Patient received recommended doses of hepatitis b vaccination based on age
- M1469Patient has a history of hepatitis b illness or received a hepatitis b surface antigen, hepatitis b surface antibody, or total antibody to hepatitis b core antigen test with a positive result any time before or during the measurement period
- M1470Documentation of medical reason(s) for not administering hepatitis b vaccine (e.g., prior anaphylaxis due to the hepatitis b vaccine)
- M1471Documentation that patient is a medicare fee-for-service beneficiary and without additional supplementary insurance coverage for whom hep b vaccination is not reimbursable under current medicare part b coverage rules
- M1472Patient did not receive recommended doses of hepatitis b vaccination based on age
- M1474Patients with diagnosis of dementia
- M1475Patients with diagnosis of huntington's disease
- M1476Patients with diagnosis of cognitive impairment or alzheimer's disease
- M1477Diagnosis of delirium
- M1478Psychoactive substance abuse
- M1479Patients whose functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders
- M1480Patients whose functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders
- M1481Patients receiving hospice or palliative care or who died during the measurement period
Questions about M1473
What is HCPCS code M1473?
M1473 is a HCPCS Level II code for patient situations, at any point during the denominator identification period, where the patient's functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools, such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders. It sits in the Medical Services section.
Does Medicare cover M1473?
The CMS HCPCS file marks M1473 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 M1473 paid under the physician fee schedule?
M1473 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.