M1286 — Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason
M1286 is a HCPCS Level II code for bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason. 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 M1286
- Long descriptor
- Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason
- Short descriptor
- Bmi doc onl fup not cmpltd
- 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 M1286
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1286 is not quite right, the correct code is very often within a few positions of it.
- 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
- M1280Women 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
- 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
- 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
- M1289Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)
- M1290Patient not eligible due to active diagnosis of hypertension
- M1291Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
- M1292Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period
- M1293Bmi is documented above normal parameters and a follow-up plan is documented
- M1294Normal blood pressure reading documented, follow-up not required
Questions about M1286
What is HCPCS code M1286?
M1286 is a HCPCS Level II code for bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reason. It sits in the Medical Services section.
Does Medicare cover M1286?
The CMS HCPCS file marks M1286 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 M1286 paid under the physician fee schedule?
M1286 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.