M1221 — Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy
M1221 is a HCPCS Level II code for dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy. 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 M1221
- Long descriptor
- Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy
- Short descriptor
- Dre w/o rtnopthy
- Added
- January 1, 2024
- 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 M1221
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1221 is not quite right, the correct code is very often within a few positions of it.
- 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)
- M1218Patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing)
- M1219Anaphylaxis due to the vaccine on or before the date of the encounterterminated
- M1220Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; with evidence of retinopathy
- M1222Glaucoma plan of care not documented, reason not otherwise specified
- M1223Glaucoma plan of care documented
- M1224Intraocular pressure (iop) reduced by a value less than 20% from the pre-intervention level
- M1225Intraocular pressure (iop) reduced by a value of greater than or equal to 20% from the pre-intervention level
- M1226Iop measurement not documented, reason not otherwise specified
- M1227Evidence-based therapy was prescribed
- M1228Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, has hcv treatment initiated within 3 months of the reactive hcv antibody test
- M1229Patient, who has a reactive hcv antibody test, and has a follow up hcv viral test that detected hcv viremia, is referred within 1 month of the reactive hcv antibody test to a clinician who treats hcv infection
Questions about M1221
What is HCPCS code M1221?
M1221 is a HCPCS Level II code for dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy. It sits in the Medical Services section.
Does Medicare cover M1221?
The CMS HCPCS file marks M1221 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 M1221 paid under the physician fee schedule?
M1221 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.