M1255 HCPCS Level II code: Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the…
M1255 is the HCPCS code for “Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to…” in CMS’s October 2026 release, in effect from Oct 1, 2026.
Official description
M1255Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere)
Short description: Pts w/ othr rsn vst,+prg tst
HCPCS · United States
Medicare details
The indicators CMS publishes with M1255 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 M1255 sits
- 1M codesMedical services and quality measures
- 2Active code M1255Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere)
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 M1255 mean?
M1255 is the HCPCS code for “Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an ob provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere)” in CMS’s HCPCS Level II October 2026 release.
Does Medicare cover M1255?
CMS lists M1255’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 M1255
All M codesM1249Patient responded "completely true" for the question of patient felt this provider and team understood what is important to me in my lifeM1250Patient responded as "completely true" for the question of patient felt heard and understood by this provider and teamM1251Patients for whom a proxy completed the entire hu survey on their behalf for any reason (no patient involvement)M1252Patients who did not complete at least one of the four patient experience hu survey items and return the hu survey within 60 days of the ambulatory palliative care visitM1253Patients who respond on the patient experience hu survey that they did not receive care by the listed ambulatory palliative care provider in the last 60 days (disavowal)M1254Patients who were deceased when the hu survey reached themM1256Prior history of known cvdM1257Cvd risk assessment not performed or incomplete (e.g., cvd risk assessment was not documented), reason not otherwise specifiedM1258Cvd risk assessment performed, have a documented calculated risk scoreM1259Patient status documented within the first year of initiating dialysisM1260Patient status not documented within the first year of initiating dialysisM1261Patients that were on the kidney or kidney-pancreas waitlist prior to initiation of dialysis