M1292 HCPCS Level II code: Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the…
M1292 is the HCPCS code for “Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to…” in CMS’s October 2026 release, in effect from Oct 1, 2026.
Official description
M1292Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period
Short description: Pt 66+ frail inpt adv ill
HCPCS · United States
Medicare details
The indicators CMS publishes with M1292 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 M1292 sits
- 1M codesMedical services and quality measures
- 2Active code M1292Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement 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 M1292 mean?
M1292 is the HCPCS code for “Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period” in CMS’s HCPCS Level II October 2026 release.
Does Medicare cover M1292?
CMS lists M1292’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 M1292
All M codesM1286Bmi is documented as being outside of normal parameters, follow-up plan is not completed for documented medical reasonM1287Bmi is documented below normal parameters and a follow-up plan is documentedM1288Documented reason for not screening or recommending a follow-up for high blood pressureM1289Patient identified as tobacco user did not receive tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling…M1290Patient not eligible due to active diagnosis of hypertensionM1291Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement…M1293Bmi is documented above normal parameters and a follow-up plan is documentedM1294Normal blood pressure reading documented, follow-up not requiredM1295Patients with a diagnosis or past history of total colectomy or colorectal cancerM1296Bmi is documented within normal parameters and no follow-up plan is requiredM1297Bmi not documented due to medical reason or patient refusal of height or weight measurementM1298Documentation of patient pregnancy anytime during the measurement period prior to and including the current encounter