M1123 HCPCS Level II code: Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as…
M1123 is the HCPCS code for “Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record” in CMS’s October 2026 release, in effect from Oct 1, 2026.
Official description
M1123Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record
Short description: Oc ni pt home prog
HCPCS · United States
Medicare details
The indicators CMS publishes with M1123 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, 2020
Where M1123 sits
- 1M codesMedical services and quality measures
- 2Active code M1123Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record
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 M1123 mean?
M1123 is the HCPCS code for “Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical record” in CMS’s HCPCS Level II October 2026 release.
Does Medicare cover M1123?
CMS lists M1123’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 M1123
All M codesM1117Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of careM1118Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical…M1119Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became…M1120Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)M1121The start of an episode of care documented in the medical recordM1122Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of careM1124Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became…M1125Ongoing care not possible because the patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown)M1126The start of an episode of care documented in the medical recordM1127Documentation stating patient has a diagnosis of a degenerative neurological condition such as als, ms, or parkinson's diagnosed at any time before or during the episode of careM1128Ongoing care not clinically indicated because the patient needed a home program only, referral to another provider or facility, or consultation only, as documented in the medical…M1129Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became…