M1280 — Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy
M1280 is a HCPCS Level II code for women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy. 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 M1280
- Long descriptor
- Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy
- Short descriptor
- Bilat mast/hx bi /unilat mas
- 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 M1280
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1280 is not quite right, the correct code is very often within a few positions of it.
- M1272Patients observed on any kidney or kidney-pancreas transplant waitlist as of the last day of each month during the measurement period
- M1273Patients who were admitted to a skilled nursing facility (snf) within one year of dialysis initiation according to the cms-2728 form
- M1274Patients who were admitted to a skilled nursing facility (snf) during the month of evaluation were excluded from that month
- M1275Patients determined to be in hospice were excluded from month of evaluation and the remainder of reporting period
- M1276Bmi documented outside normal parameters, no follow-up plan documented, no reason given
- M1277Colorectal cancer screening results documented and reviewed
- M1278Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented
- M1279Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given
- M1281Blood pressure reading not documented, reason not given
- M1282Patient screened for tobacco use and identified as a tobacco non-user
- M1283Patient screened for tobacco use and identified as a tobacco user
- M1284Patients age 66 or older in institutional special needs plans (snp) or residing in long term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period
- M1285Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified
- M1286Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason
- M1287Bmi is documented below normal parameters and a follow-up plan is documented
- M1288Documented reason for not screening or recommending a follow-up for high blood pressure
Questions about M1280
What is HCPCS code M1280?
M1280 is a HCPCS Level II code for women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy. It sits in the Medical Services section.
Does Medicare cover M1280?
The CMS HCPCS file marks M1280 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 M1280 paid under the physician fee schedule?
M1280 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.