M1054 HCPCS Level II code: Patient had only urgent care visits during the performance period
M1054 is the HCPCS code for “Patient had only urgent care visits during the performance period” in CMS’s October 2026 release, in effect from Oct 1, 2026.
Official description
M1054Patient had only urgent care visits during the performance period
Short description: Pt uc in pp
HCPCS · United States
Medicare details
The indicators CMS publishes with M1054 in its October 2026 file. They describe Medicare’s handling, not another payer’s.
- Medicare coverage
- Carrier judgment
- Medicare pricing
- Service not separately priced by Part B (e.g., services not covered, bundled, used by Part A only, etc.)
- Type of service
- Medical care
- BETOS category
- Undefined codes
- Added
- Jan 1, 2019
Where M1054 sits
- 1M codesMedical services and quality measures
- 2Active code M1054Patient had only urgent care visits during the performance period
Source and release
- Data release
- HCPCS Level II · October 2026
- Effective date
- Oct 1, 2026
- Publisher
- CMS
This page is built from the HCPCS Level II catalog that Vero Codes reads when it suggests codes: Centers for Medicare & Medicaid Services’s October 2026 release, imported from the publisher’s file and checked against it. The description, notes and structured data come from the same record.
Frequently asked questions
What does HCPCS code M1054 mean?
M1054 is the HCPCS code for “Patient had only urgent care visits during the performance period” in CMS’s HCPCS Level II October 2026 release.
Does Medicare cover M1054?
CMS lists M1054’s Medicare coverage as “Carrier judgment” and its pricing as “Service not separately priced by Part B (e.g., services not covered, bundled, used by Part A only, etc.)”. Coverage and payment still depend on the patient, the setting, the documentation and the payer.
Which HCPCS Level II release does this page use?
It uses CMS’s October 2026 release, in effect from Oct 1, 2026 to Dec 31, 2026. It is a reference: confirm the code against the current list and the payer’s rules before you submit it.
Codes beside M1054
All M codesM1048Functional status measurement with score was obtained utilizing the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively…M1049Functional status was not measured by the oswestry disability index (odi version 2.1a) at three months (6 - 20 weeks) postoperativelyM1050Functional status was measured by the oswestry disability index (odi version 2.1a) patient reported outcome tool within three months preoperatively and at three months (6 to 20…M1051Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosisM1052Leg pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperativelyM1053Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperativelyM1055Aspirin or another antiplatelet therapy usedM1056Prescribed anticoagulant medication during the performance period, history of gi bleeding, history of intracranial bleeding, bleeding disorder and specific provider documented…M1057Aspirin or another antiplatelet therapy not used, reason not givenM1058Patient was a permanent nursing home resident at any time during the performance periodM1059Patient was in hospice or receiving palliative care at any time during the performance periodM1060Patient died prior to the end of the performance period