M1338 HCPCS Level II code: Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning…
M1338 is the HCPCS code for “Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores during the performance period” in CMS’s October 2026 release, in effect from Oct 1, 2026.
Official description
M1338Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores during the performance period
Short description: Pt f/u 30-180 dys no + imprv
HCPCS · United States
Medicare details
The indicators CMS publishes with M1338 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 M1338 sits
- 1M codesMedical services and quality measures
- 2Active code M1338Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores 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 M1338 mean?
M1338 is the HCPCS code for “Patients who had follow-up assessment 30 to 180 days after the index assessment who did not demonstrate positive improvement or maintenance of functioning scores during the performance period” in CMS’s HCPCS Level II October 2026 release.
Does Medicare cover M1338?
CMS lists M1338’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 M1338
All M codesM1332Patients who were not appropriately evaluated during the initial exam and/or who were not re-evaluated within 2 weeksM1333Acute vitreous hemorrhageM1334Patients with a post-operative encounter of the eye with the acute pvd within 2 weeks before the initial encounter or 2 weeks after initial acute pvd encounterM1335Documentation of patient reason(s) for not having a follow up exam (e.g., inadequate time for follow up)M1336Patients who were appropriately evaluated during the initial exam and were re-evaluated no later than 2 weeksM1337Acute pvdM1339Patients who had follow-up assessment 30 to 180 days after the index assessment who demonstrated positive improvement or maintenance of functioning scores during the performance…M1340Index assessment completed using the 12-item whodas 2.0 or sds during the denominator identification periodM1341Patients who did not have a follow-up assessment or did not have an assessment within 30 to 180 days after the index assessment during the performance periodM1342Patients who died during the performance periodM1343Patients who are at pam level 4 at baseline or patients who are flagged with extreme straight line response sets on the pam or with excessive missing responsesM1344Patients who did not have a baseline pam score and/or a second score within 4 to 12 months of baseline pam score