M1209 — At least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses
M1209 is a HCPCS Level II code for at least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses. 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 M1209
- Long descriptor
- At least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses
- Short descriptor
- >=2 same hi-rsk med w/o diag
- 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 M1209
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1209 is not quite right, the correct code is very often within a few positions of it.
- 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
- 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%
- M1212Glycemic status assessment (hba1c or gmi) level is missing, or was not performed during the measurement period
- M1213No history of spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) and present spirometry is >= 70%
- M1214Spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and reviewed
- M1215Documentation of medical reason(s) for not documenting and reviewing spirometry results (e.g., patients with dementia or tracheostomy)
- M1216No spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and/or no spirometry performed with results documented during the encounter
- M1217Documentation of system reason(s) for not documenting and reviewing spirometry results (e.g., spirometry equipment not available at the time of the encounter)
Questions about M1209
What is HCPCS code M1209?
M1209 is a HCPCS Level II code for at least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses. It sits in the Medical Services section.
Does Medicare cover M1209?
The CMS HCPCS file marks M1209 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 M1209 paid under the physician fee schedule?
M1209 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.