M1397 HCPCS Level II code: Patients with recurrence/disease progression
M1397 is the HCPCS code for “Patients with recurrence/disease progression” in CMS’s October 2026 release, in effect from Oct 1, 2026.
Official description
M1397Patients with recurrence/disease progression
Short description: Pt w/ recur/prog
HCPCS · United States
Medicare details
The indicators CMS publishes with M1397 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 M1397 sits
- 1M codesMedical services and quality measures
- 2Active code M1397Patients with recurrence/disease progression
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 M1397 mean?
M1397 is the HCPCS code for “Patients with recurrence/disease progression” in CMS’s HCPCS Level II October 2026 release.
Does Medicare cover M1397?
CMS lists M1397’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 M1397
All M codesM1391All patients who were diagnosed with recurrent melanoma during the current performance periodM1392Documentation of patient reasons for no examination, i.e., refusal of examination or lost to follow-up (documentation must include information that the clinician was unable to…M1393Patients who were not diagnosed with recurrent melanoma during the current performance periodM1394Stages i-iii breast cancerM1395Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or groupM1396Patients on a therapeutic clinical trialM1398Patients with baseline and follow-up promis surveys documented in the medical recordM1399Patients who leave the practice during the follow-up periodM1400Patients who died during the follow-up periodM1401Stages i-iii breast cancerM1402Patients receiving an initial chemotherapy regimen with a defined duration with the eligible clinician or groupM1403Patients with baseline and follow-up promis surveys documented in the medical record