HCPCS Level II · Medical services and quality measures
M1255Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere)
✓ Active
Source: CMS HCPCS quarterly update, October 2026. Page updated September 29, 2026.
About M1255
M1255 is an HCPCS Level II code in the M series (medical services and quality measures), describing patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere).
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
- Pts w/ othr rsn vst,+prg tst
- 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 M1255
Is HCPCS M1255 still valid?
- Yes. M1255 is active in the CMS October 2026 HCPCS file.
Does Medicare cover M1255?
- Its coverage code is "C": coverage is left to the Medicare contractor's judgment. Check the local coverage determination for your region.