M1263 — Patients in hospice on their initiation of dialysis date or during the month of evaluation
M1263 is a HCPCS Level II code for patients in hospice on their initiation of dialysis date or during the month of evaluation. 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 M1263
- Long descriptor
- Patients in hospice on their initiation of dialysis date or during the month of evaluation
- Short descriptor
- Pts hosp dialysis dt
- 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 M1263
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1263 is not quite right, the correct code is very often within a few positions of it.
- M1255Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere)
- M1256Prior history of known cvd
- M1257Cvd risk assessment not performed or incomplete (e.g., cvd risk assessment was not documented), reason not otherwise specified
- M1258Cvd risk assessment performed, have a documented calculated risk score
- M1259Patient status documented within the first year of initiating dialysis
- M1260Patient status not documented within the first year of initiating dialysis
- M1261Patients that were on the kidney or kidney-pancreas waitlist prior to initiation of dialysis
- M1262Patients who had a transplant prior to initiation of dialysis
- M1264Patients age 75 or older on their initiation of dialysis dateterminated
- M1265Cms medical evidence form 2728 for dialysis patients: initial form completed
- M1266Patients admitted to a skilled nursing facility (snf)
- M1267Patients not observed in active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
- M1268Patients observed in active status on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
- M1269Receiving esrd mcp dialysis services by the provider on the last day of the reporting month
- M1270Patients not on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
- M1271Patients with dementia at any time prior to or during the month
Questions about M1263
What is HCPCS code M1263?
M1263 is a HCPCS Level II code for patients in hospice on their initiation of dialysis date or during the month of evaluation. It sits in the Medical Services section.
Does Medicare cover M1263?
The CMS HCPCS file marks M1263 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 M1263 paid under the physician fee schedule?
M1263 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.