M1497: Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy)
M1497 is a HCPCS Level II code for documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy). 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 2026Q4-Oct. 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 M1497
- Long descriptor
- Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy)
- Short descriptor
- No doc fall med rsn
- 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 M1497
HCPCS has no hierarchy: related items simply sit next to each other in the numbering. If M1497 is not quite right, the correct code is very often within a few positions of it.
- M1489Patient status documented
- M1490Patient status not documented
- M1491Receiving esrd mcp dialysis services by the provider during the performance period
- M1492Patients who did not report a fall
- M1493Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury (mtbi), cervical dystonia, or epilepsy)
- M1494Patients that reported a fall since the last visit
- M1495Patients that reported a fall occurred who had a plan of care for falls documented or patients that did not report a fall
- M1496Patients that had a fall who did not have a plan of care for falls documented or do not have documentation of being assessed for falls
- M1498Diagnostic radiology mips value pathway
- M1499Interventional radiology mips value pathway
- M1500Neuropsychology mips value pathway
- M1501Pathology mips value pathway
- M1502Podiatry mips value pathway
- M1503Vascular surgery mips value pathway
- P2028Cephalin floculation, blood
- P2029Congo red, blood