M1004 — Documentation of medical reason for not screening for tb or interpreting results (i.e., patient positive for tb and documentation of past treatment; patient who has recently completed a course of anti-tb therapy)
M1004 is a HCPCS Level II code for documentation of medical reason for not screening for tb or interpreting results (i.e., patient positive for tb and documentation of past treatment; patient who has recently completed a course of anti-tb therapy). 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 M1004
- Long descriptor
- Documentation of medical reason for not screening for tb or interpreting results (i.e., patient positive for tb and documentation of past treatment; patient who has recently completed a course of anti-tb therapy)
- Short descriptor
- Doc med rsn no srn tb
- Added
- January 1, 2019
- 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 M1004
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1004 is not quite right, the correct code is very often within a few positions of it.
- M0249Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, first dose
- M0250Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, second dose
- M0300Iv chelation therapy (chemical endarterectomy)
- M0301Fabric wrapping of abdominal aneurysm
- M1000Pain screened as moderate to severeterminated
- M1001Plan of care to address moderate to severe pain documented on or before the date of the second visit with a clinicianterminated
- M1002Plan of care for moderate to severe pain not documented on or before the date of the second visit with a clinician, reason not giventerminated
- M1003Tb screening performed and results interpreted within twelve months prior to initiation of first-time biologic and/or immune response modifier therapy
- M1005Tb screening not performed or results not interpreted, reason not given
- M1006Disease activity not assessed, reason not given
- M1007>=50% of total number of a patient's outpatient ra encounters assessed
- M1008<50% of total number of a patient's outpatient ra encounters assessed
- M1009Discharge/discontinuation of the episode of care documented in the medical record
- M1010Discharge/discontinuation of the episode of care documented in the medical record
- M1011Discharge/discontinuation of the episode of care documented in the medical record
- M1012Discharge/discontinuation of the episode of care documented in the medical record
Questions about M1004
What is HCPCS code M1004?
M1004 is a HCPCS Level II code for documentation of medical reason for not screening for tb or interpreting results (i.e., patient positive for tb and documentation of past treatment; patient who has recently completed a course of anti-tb therapy). It sits in the Medical Services section.
Does Medicare cover M1004?
The CMS HCPCS file marks M1004 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 M1004 paid under the physician fee schedule?
M1004 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.