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M1196

M1196Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4

HCPCSActiveBETOS Z2

M1196 is a HCPCS Level II code for initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4. 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 M1196

Long descriptor
Initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4

The official wording. This is what the code means.

Short descriptor
Ixv nrs vrs iqa >=4

CMS's 28-character form, which is what shows up on a remittance advice.

Added
January 1, 2023

When CMS introduced the code.

BETOS
Z2

Berenson-Eggers Type of Service — CMS's own analytic grouping.

Pricing indicator
00 — Not priced by Part B

Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.

Codes adjacent to M1196

HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1196 is not quite right, the correct code is very often within a few positions of it.

  • M1188Patients with a diagnosis of chronic kidney disease (ckd) stage 5
  • M1189Documentation of a kidney health evaluation defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr) performed
  • M1190Documentation of a kidney health evaluation was not performed or defined by an estimated glomerular filtration rate (egfr) and urine albumin-creatinine ratio (uacr)
  • M1191Hospice services provided to patient any time during the measurement period
  • M1192Patients with an existing diagnosis of squamous cell carcinoma of the esophagus
  • M1193Surgical pathology reports that contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both
  • M1194Documentation of medical reason(s) surgical pathology reports did not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both tests were not included (e.g., patient will not be treated with checkpoint inhibitor therapy, no residual carcinoma is present in the sample [tissue exhausted or status post neoadjuvant treatment], insufficient tumor for testing)
  • M1195Surgical pathology reports that do not contain impression or conclusion of or recommendation for testing of mmr by immunohistochemistry, msi by dna-based testing status, or both, reason not given
  • M1197Itch severity assessment score is reduced by 3 or more points from the initial (index) assessment score to the follow-up visit score
  • M1198Itch 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
  • M1199Patients receiving rrt
  • 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

Questions about M1196

What is HCPCS code M1196?

M1196 is a HCPCS Level II code for initial (index visit) numeric rating scale (nrs), visual rating scale (vrs), or itchyquant assessment score of greater than or equal to 4. It sits in the Medical Services section.

Does Medicare cover M1196?

The CMS HCPCS file marks M1196 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 M1196 paid under the physician fee schedule?

M1196 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.

HCPCS Level II2026Q3-Jul· effective July 1, 2026