HCPCS Level II · Medical services and quality measures
M1221Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy
✓ Active
Source: CMS HCPCS quarterly update, October 2026. Page updated September 29, 2026.
About M1221
M1221 is an HCPCS Level II code in the M series (medical services and quality measures), describing dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy.
It was added to HCPCS effective 01/01/2024.
Its Medicare coverage code is "C", meaning coverage is left to the Medicare contractor's judgment.
Details
- Short description
- Dre w/o rtnopthy
- Date added
- 01/01/2024
- Action effective
- 01/01/2024
- BETOS
- Z2
Related M12xx codes
- M1200Ace inhibitor (ace-i) or arb therapy prescribed during the measurement period
- M1201Documentation of medical reason(s) for not prescribing ace inhibitor (ace-i) or arb therapy during the measurement period (e.g., pregnancy, history of angioedema to ace-i, other allergy to ace-i and arb, hyperkalemia or history of hyperkalemia while on ace-i or arb therapy, acute kidney injury due to ace-i or arb therapy), other medical reasons)
- M1202Documentation of patient reason(s) for not prescribing ace inhibitor or arb therapy during the measurement period, (e.g., patient declined, other patient reasons)
- M1203Ace inhibitor or arb therapy not prescribed during the measurement period, reason not given
- M1204Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4
- M1205Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score
- M1206Itch severity assessment score was not reduced by at least 3 points from initial (index) score to the follow-up visit score or assessment was not completed during the follow-up encounter
- M1207Patient is screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
- M1208Patient is not screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety
- M1209At least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses
- M1210At least two orders for high-risk medications from the same drug class, (table 4), not ordered
- M1211Most recent glycemic status assessment (hba1c or gmi) level > 9.0%
Common questions about M1221
Is HCPCS M1221 still valid?
- Yes. M1221 is active in the CMS October 2026 HCPCS file.
Does Medicare cover M1221?
- Its coverage code is "C": coverage is left to the Medicare contractor's judgment. Check the local coverage determination for your region.