2025 HCPCS Code M1292

Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period

TAGS: illness patients prior advanced frailty inpatient encounter acute period nonacute older encounters years dates service diagnosis different during measurement either least
Short DescriptionPt 66+ frail inpt adv ill
HCPCS Action Code N - No maintenance for this code
HCPCS Coverage Code C - Carrier judgment
HCPCS Code Added Date January 01, 2024
HCPCS Action Effective Date January 01, 2024
HCPCS Pricing Indicator Code 00 - Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
HCPCS Type Of Service Code 1 - Medical care
HCPCS Multiple Pricing Indicator Code 9 - Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
HCPCS Anesthesia Base Unit Quantity 0
HCPCS Coverage Issues Manual Reference Section Number

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