M1038 — Patients with a diagnosis of lumbar spine region fracture at the time of the procedure
M1038 is a HCPCS Level II code for patients with a diagnosis of lumbar spine region fracture at the time of the procedure. 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
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The CMS record for M1038
- Long descriptor
- Patients with a diagnosis of lumbar spine region fracture at the time of the procedure
- Short descriptor
- Pt dx lum sp reg fract
- 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 M1038
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1038 is not quite right, the correct code is very often within a few positions of it.
- M1030Patients with clinical indications for imaging of the headterminated
- M1031Patients with no clinical indications for imaging of the headterminated
- M1032Adults currently taking pharmacotherapy for oud
- M1033Pharmacotherapy for oud initiated after june 30th of performance periodterminated
- M1034Adults who have at least 180 days of continuous pharmacotherapy with a medication prescribed for oud without a gap of more than seven days
- M1035Adults who are deliberately phased out of medication assisted treatment (mat) prior to 180 days of continuous treatment
- M1036Adults who have not had at least 180 days of continuous pharmacotherapy with a medication prescribed for oud without a gap of more than seven days
- M1037Patients with a diagnosis of lumbar spine region cancer at the time of the procedure
- M1039Patients with a diagnosis of lumbar spine region infection at the time of the procedure
- M1040Patients with a diagnosis of lumbar idiopathic or congenital scoliosis
- M1041Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis
- M1042Functional status measurement with score was obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperativelyterminated
- M1043Functional status was not measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively
- M1044Functional status was measured by the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperativelyterminated
- M1045Functional status measured by the oxford knee score (oks) at one year (9 to 15 months) postoperatively was greater than or equal to 37 or knee injury and osteoarthritis outcome score joint replacement (koos, jr.) was greater than or equal to 71
- M1046Functional status measured by the oxford knee score (oks) at one year (9 to 15 months) postoperatively was less than 37 or the knee injury and osteoarthritis outcome score joint replacement (koos, jr.) was less than 71 postoperatively
Questions about M1038
What is HCPCS code M1038?
M1038 is a HCPCS Level II code for patients with a diagnosis of lumbar spine region fracture at the time of the procedure. It sits in the Medical Services section.
Does Medicare cover M1038?
The CMS HCPCS file marks M1038 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 M1038 paid under the physician fee schedule?
M1038 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.