M1221 HCPCS Level II code: Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed…
M1221 is the HCPCS code for “Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy” in CMS’s October 2026 release, in effect from Oct 1, 2026.
Official description
M1221Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy
Short description: Dre w/o rtnopthy
HCPCS · United States
Medicare details
The indicators CMS publishes with M1221 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, 2024
Where M1221 sits
- 1M codesMedical services and quality measures
- 2Active code M1221Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy
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 M1221 mean?
M1221 is the HCPCS code for “Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; without evidence of retinopathy” in CMS’s HCPCS Level II October 2026 release.
Does Medicare cover M1221?
CMS lists M1221’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 M1221
All M codesM1215Documentation of medical reason(s) for not documenting and reviewing spirometry results (e.g., patients with dementia or tracheostomy)M1216No spirometry results with confirmed airflow obstruction (fev1/fvc < 70%) documented and/or no spirometry performed with results documented during the encounterM1217Documentation of system reason(s) for not documenting and reviewing spirometry results (e.g., spirometry equipment not available at the time of the encounter)M1218Patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing)M1219Anaphylaxis due to the vaccine on or before the date of the encounterM1220Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist or artificial intelligence (ai) interpretation documented and reviewed; with evidence of…M1222Glaucoma plan of care not documented, reason not otherwise specifiedM1223Glaucoma plan of care documentedM1224Intraocular pressure (iop) reduced by a value less than 20% from the pre-intervention levelM1225Intraocular pressure (iop) reduced by a value of greater than or equal to 20% from the pre-intervention levelM1226Iop measurement not documented, reason not otherwise specifiedM1227Evidence-based therapy was prescribed