M1415 — Patients who did not have a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy
M1415 is a HCPCS Level II code for patients who did not have a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy. 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
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
The CMS record for M1415
- Long descriptor
- Patients who did not have a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy
- Short descriptor
- No pos pdl1 bef ici ther
- Added
- January 1, 2025
- 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 M1415
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If M1415 is not quite right, the correct code is very often within a few positions of it.
- M1407Patients who died during the follow-up period
- M1408Patients who have germline brca testing completed before diagnosis of epithelial ovarian, fallopian tube, or primary peritoneal cancer
- M1409Patients who received germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis
- M1410Patients who did not have germline testing for brca1 and brca2 or genetic counseling completed within 6 months of diagnosis
- M1411Currently on first-line immune checkpoint inhibitors without chemotherapy
- M1412Patients with metastatic nsclc with epidermal growth factor receptor (egfr) mutations, alk genomic tumor aberrations, or other targetable genomic abnormalities with approved first-line targeted therapy, such as nsclc with ros1 rearrangement, braf v600e mutation, ntrk 1/2/3 gene fusion, met ex14 skipping mutation, and ret rearrangement
- M1413Patients who had a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy
- M1414Documentation of medical reason(s) for not performing the pd-l1 biomarker expression test prior to initiation of first-line immune checkpoint inhibitor therapy (e.g., patient is in an urgent or emergent situation where delay of treatment would jeopardize the patient's health status; other medical reasons/contraindication)
- M1416Patient received hospice services any time during the performance period
- M1417Patients who are up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination
- M1418Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination because of a medical contraindication documented by clinician
- M1419Patients who are not up to date on their covid-19 vaccinations as defined by cdc recommendations on current vaccination
- M1420Complete ophthalmologic care mips value pathway
- M1421Dermatological care mips value pathway
- M1422Gastroenterology care mips value pathway
- M1423Optimal care for patients with urologic conditions mips value pathway
Questions about M1415
What is HCPCS code M1415?
M1415 is a HCPCS Level II code for patients who did not have a positive pd-l1 biomarker expression test result prior to the initiation of first-line immune checkpoint inhibitor therapy. It sits in the Medical Services section.
Does Medicare cover M1415?
The CMS HCPCS file marks M1415 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 M1415 paid under the physician fee schedule?
M1415 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.