M1292 — Patients 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
M1292 is a HCPCS Level II code for patients 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. 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 M1292
- Long descriptor
- Patients 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
- Short descriptor
- Pt 66+ frail inpt adv ill
- 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 M1292
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1292 is not quite right, the correct code is very often within a few positions of it.
- 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
- 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
- M1293Bmi is documented above normal parameters and a follow-up plan is documented
- M1294Normal blood pressure reading documented, follow-up not required
- M1295Patients with a diagnosis or past history of total colectomy or colorectal cancer
- M1296Bmi is documented within normal parameters and no follow-up plan is required
- M1297Bmi not documented due to medical reason or patient refusal of height or weight measurement
- M1298Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter
- M1299Influenza immunization administered or previously received
- M1300Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)
Questions about M1292
What is HCPCS code M1292?
M1292 is a HCPCS Level II code for patients 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. It sits in the Medical Services section.
Does Medicare cover M1292?
The CMS HCPCS file marks M1292 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 M1292 paid under the physician fee schedule?
M1292 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.