M0005 — Value in primary care mips value pathway
M0005 is a HCPCS Level II code for value in primary care mips value pathway. 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 M0005
- Long descriptor
- Value in primary care mips value pathway
- Short descriptor
- Value in primary care mvp
- Added
- January 1, 2023
- 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 M0005
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M0005 is not quite right, the correct code is very often within a few positions of it.
- L8702Powered upper extremity range of motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated
- L8720External lower extremity sensory prosthetic device, cutaneous stimulation of mechanoreceptors proximal to the ankle, per leg
- L8721Receptor sole for use with l8720, replacement, each
- L9900Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code
- M0001Advancing cancer care mips value pathways
- M0002Optimal care for kidney health mips value pathways
- M0003Optimal care for patients with episodic neurological conditions mips value pathwaysterminated
- M0004Quality care for patients with neurological conditions mips value pathway
- M0010Enhancing oncology model (eom) monthly enhanced oncology services (meos) payment for eom enhanced services
- M0064Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental psychoneurotic and personality disordersterminated
- M0075Cellular therapy
- M0076Prolotherapy
- M0100Intragastric hypothermia using gastric freezing
- M0201Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient's home
- M0220Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoringterminated
- M0221Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergencyterminated
Questions about M0005
What is HCPCS code M0005?
M0005 is a HCPCS Level II code for value in primary care mips value pathway. It sits in the Medical Services section.
Does Medicare cover M0005?
The CMS HCPCS file marks M0005 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 M0005 paid under the physician fee schedule?
M0005 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.