M1375 HCPCS Level II code: An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter…
M1375 is the HCPCS code for “An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the…” in CMS’s October 2026 release, in effect from Oct 1, 2026.
Official description
M1375An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period
Short description: Ra dx enc 90 days dur per pd
HCPCS · United States
Medicare details
The indicators CMS publishes with M1375 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, 2025
Where M1375 sits
- 1M codesMedical services and quality measures
- 2Active code M1375An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis 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 M1375 mean?
M1375 is the HCPCS code for “An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis during the performance period” in CMS’s HCPCS Level II October 2026 release.
Does Medicare cover M1375?
CMS lists M1375’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 M1375
All M codesM1369Quality care in mental health and substance use disorders mips value pathwayM1370Rehabilitative support for musculoskeletal care mips value pathwayM1371Most recent glycemic status assessment (hba1c or gmi) level < 7.0%M1372Most recent glycemic status assessment (hba1c or gmi) level >= 7.0% and < 8.0%M1373Most recent glycemic status assessment (hba1c or gmi) level >= 8.0% and <= 9.0%M1374An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis…M1376An additional encounter with an ra diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an ra diagnosis…M1377Recommended follow-up interval for repeat colonoscopy of 10 years documented in colonoscopy report and communicated with patientM1378Documentation of medical reason(s) for not recommending a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no…M1379A 10 year follow-up interval for colonoscopy not recommended, reason not otherwise specifiedM1380Filled at least two prescriptions during the performance period for any combination of the qualifying oral antipsychotic medications listed under "denominator note" or the…M1381Patients with secondary stroke (e.g., a subsequent stroke that may occur with vasospasm in the setting of subarachnoid hemorrhage) within 5 days of the initial procedure