M1304 — Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
M1304 is a HCPCS Level II code for patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of 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 M1304
- Long descriptor
- Patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
- Short descriptor
- No pneum vax admin 19+
- 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 M1304
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1304 is not quite right, the correct code is very often within a few positions of it.
- 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)
- M1301Patient identified as a tobacco user received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling and/or pharmacotherapy)
- M1302Screening, diagnostic, film digital or digital breast tomosynthesis (3d) mammography results documented and reviewed
- M1303Hospice services provided to patient any time during the measurement period
- M1305Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period
- M1306Patient had anaphylaxis due to the pneumococcal vaccine any time during or before the measurement period
- M1307Documentation stating the patient has received or is currently receiving palliative or hospice care
- M1308Influenza immunization was not administered, reason not given
- M1309Palliative care services provided to patient any time during the measurement period
- M1310Patient screened for tobacco use and received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling, pharmacotherapy, or both), if identified as a tobacco user
- M1311Anaphylaxis due to the vaccine on or before the date of the encounter
- M1312Patient not screened for tobacco use
Questions about M1304
What is HCPCS code M1304?
M1304 is a HCPCS Level II code for patient did not receive any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period. It sits in the Medical Services section.
Does Medicare cover M1304?
The CMS HCPCS file marks M1304 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 M1304 paid under the physician fee schedule?
M1304 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.